Provider Demographics
NPI:1578746921
Name:PAUL T YODER MD PLLC
Entity Type:Organization
Organization Name:PAUL T YODER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-363-1173
Mailing Address - Street 1:904 N OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-6601
Mailing Address - Country:US
Mailing Address - Phone:928-363-1173
Mailing Address - Fax:928-363-1173
Practice Address - Street 1:904 N OVERLOOK CIR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-6601
Practice Address - Country:US
Practice Address - Phone:928-363-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0735560OtherBLUE CROSS
AZAZ0735560OtherBLUE CROSS
C24695Medicare UPIN