Provider Demographics
NPI:1578521936
Name:YEAGER, ROBERT T (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:YEAGER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:964 W IDAHO AVE
Mailing Address - Street 2:SNAKE RIVER RADIOLOGY PC
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2111
Mailing Address - Country:US
Mailing Address - Phone:541-889-9545
Mailing Address - Fax:541-889-8376
Practice Address - Street 1:964 W IDAHO AVE
Practice Address - Street 2:SNAKE RIVER RADIOLOGY PC
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2111
Practice Address - Country:US
Practice Address - Phone:541-889-9545
Practice Address - Fax:541-889-8376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
ORMD214872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130047Medicaid
OR130047Medicaid
OR102602Medicare ID - Type Unspecified