Provider Demographics
NPI:1548573421
Name:YODER, MARY Z (DOM, MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:Z
Last Name:YODER
Suffix:
Gender:F
Credentials:DOM, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 CANDELARIAS LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1100
Mailing Address - Country:US
Mailing Address - Phone:505-270-7786
Mailing Address - Fax:
Practice Address - Street 1:3761 CANDELARIAS LN NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1100
Practice Address - Country:US
Practice Address - Phone:505-270-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1021171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist