Provider Demographics
NPI:1821171836
Name:YEAKLEY, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:YEAKLEY
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 1:7102 SHIPP RD
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4226
Mailing Address - Country:US
Mailing Address - Phone:972-463-6890
Mailing Address - Fax:972-463-6890
Practice Address - Street 1:7102 SHIPP RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4226
Practice Address - Country:US
Practice Address - Phone:972-463-6890
Practice Address - Fax:972-463-6890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE94692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D70GOtherBLUE CROSS
TX127983806Medicaid
TX00D70GOtherBLUE CROSS
TXC23848Medicare UPIN
TXP00224140Medicare PIN