Provider Demographics
NPI:1598759540
Name:YARBERRY, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:YARBERRY
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 1749
Mailing Address - Street 2:C/O LISA KERSTIENS - CREDENTIALING
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-1749
Mailing Address - Country:US
Mailing Address - Phone:970-926-6340
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:181 W MEADOW DR
Practice Address - Street 2:800 C/O LISA KERSTIENS CREDENTIALING
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5242
Practice Address - Country:US
Practice Address - Phone:970-476-5695
Practice Address - Fax:970-476-8976
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO24126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01241264Medicaid
CO301581Medicare PIN
H3488Medicare ID - Type Unspecified
CO01241264Medicaid