Provider Demographics
NPI:1518984152
Name:YEOMANS, EDWARD R (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:YEOMANS
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 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:808 JOLIET AVE UNIT 130
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1150
Practice Address - Country:US
Practice Address - Phone:806-761-0770
Practice Address - Fax:806-761-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2853207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137060301OtherCSHCN
TX88Y697OtherBCBS
TX137060308Medicaid
TX88Y697OtherBCBS
TXF37165Medicare UPIN
TX88Y697Medicare PIN