Provider Demographics
NPI:1942372388
Name:YODER, JEFFREY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:YODER
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 1:2226 W ALTO RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4840
Mailing Address - Country:US
Mailing Address - Phone:765-868-0313
Mailing Address - Fax:765-454-0554
Practice Address - Street 1:2226 W ALTO RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-4840
Practice Address - Country:US
Practice Address - Phone:765-868-0313
Practice Address - Fax:765-454-0554
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050170207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4848090001OtherDMERC
000000274552OtherBLUE CROSS
IN300050062Medicaid
4848090001OtherDMERC