Provider Demographics
NPI:1407050339
Name:JOHN A YEZERSKI, MD
Entity Type:Organization
Organization Name:JOHN A YEZERSKI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEZERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-759-1444
Mailing Address - Street 1:300 S 8TH ST STE 178W
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2444
Mailing Address - Country:US
Mailing Address - Phone:270-759-1444
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST STE 178W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2444
Practice Address - Country:US
Practice Address - Phone:270-759-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22751207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0348760001Medicare NSC
KY6065Medicare ID - Type Unspecified