Provider Demographics
NPI:1376531152
Name:YEARGAN, WILFRED W JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:W
Last Name:YEARGAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1030 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2806
Mailing Address - Country:US
Mailing Address - Phone:205-752-1584
Mailing Address - Fax:205-752-9987
Practice Address - Street 1:1030 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2806
Practice Address - Country:US
Practice Address - Phone:205-752-1584
Practice Address - Fax:205-752-9987
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL3697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL407183036OtherMEDICARE RAILROAD
AL0923740001OtherMEDICARE DMERC
AL51007147OtherBLUE CROSS
AL000007147Medicaid
AL000007147Medicaid
C75288Medicare UPIN