Provider Demographics
NPI:1891764726
Name:YAZEL, ERIC BLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BLAINE
Last Name:YAZEL
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 1:22902 MARRS LANE
Mailing Address - Street 2:
Mailing Address - City:BORDEN
Mailing Address - State:IN
Mailing Address - Zip Code:47106
Mailing Address - Country:US
Mailing Address - Phone:812-725-5927
Mailing Address - Fax:
Practice Address - Street 1:1214 SPRING ST # 1
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-283-3993
Practice Address - Fax:812-283-7294
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062273207P00000X, 207Q00000X
KY40102207P00000X
IN01066273208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852970Medicaid
KY7100004390Medicaid
KY7100004390Medicaid