Provider Demographics
NPI:1891901674
Name:YODER, MARY KATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:YODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:VON HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:SUITE 3075
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1475
Mailing Address - Country:US
Mailing Address - Phone:904-308-7790
Mailing Address - Fax:904-296-4786
Practice Address - Street 1:4205 BELFORT RD
Practice Address - Street 2:SUITE 3075
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1475
Practice Address - Country:US
Practice Address - Phone:904-308-7790
Practice Address - Fax:904-296-4786
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242688207Q00000X
FLME 106212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine