Provider Demographics
NPI:1417029141
Name:YEAKEL, JOSEPH DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DOUGLAS
Last Name:YEAKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:1760 COUNTY RD 36
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-0943
Mailing Address - Country:US
Mailing Address - Phone:719-293-4897
Mailing Address - Fax:
Practice Address - Street 1:1760 COUNTY RD 36
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461
Practice Address - Country:US
Practice Address - Phone:719-293-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35048052174400000X
CODR - 32388207P00000X
OHOH350H48052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0563411Medicaid
D32497Medicare UPIN
OH0563411Medicaid
OHD32497Medicare UPIN