Provider Demographics
NPI:1578527933
Name:YODER, PAUL ROY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROY
Last Name:YODER
Suffix:JR
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 1:1921 MEDICAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3437
Mailing Address - Country:US
Mailing Address - Phone:540-433-2485
Mailing Address - Fax:540-433-2010
Practice Address - Street 1:1921 MEDICAL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3437
Practice Address - Country:US
Practice Address - Phone:540-433-2485
Practice Address - Fax:540-433-2010
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096733000Medicaid
VA6354785Medicaid
VA0101018754OtherMEDICAL LICENSE
WV0096733000Medicaid
VA180000073Medicare ID - Type Unspecified