Provider Demographics
NPI:1720035793
Name:YAO, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:YAO
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 1:526 CHICKASAWBA STREET
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1405
Mailing Address - Country:US
Mailing Address - Phone:870-762-2447
Mailing Address - Fax:870-762-0385
Practice Address - Street 1:526 CHICKASAWBA ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2722
Practice Address - Country:US
Practice Address - Phone:870-762-2447
Practice Address - Fax:870-762-0385
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0053208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J302Medicare ID - Type Unspecified
CAA89867Medicare UPIN