Provider Demographics
NPI:1801820154
Name:YOST, HAL R (DO)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:R
Last Name:YOST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1014 SIXTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2398
Mailing Address - Country:US
Mailing Address - Phone:231-922-9270
Mailing Address - Fax:231-922-9271
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2349
Practice Address - Country:US
Practice Address - Phone:231-922-9270
Practice Address - Fax:231-922-9271
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1151600345OtherINDIVIDUAL BLUE CROSS
MI2573166Medicaid
MI010A660000OtherGROUP BLUE CROSS
A66000063Medicare ID - Type Unspecified
MI1151600345OtherINDIVIDUAL BLUE CROSS