Provider Demographics
NPI:1952636722
Name:YAFFA, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:YAFFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 ANGIE ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3454
Mailing Address - Country:US
Mailing Address - Phone:307-316-0150
Mailing Address - Fax:
Practice Address - Street 1:821 ANGIE ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3454
Practice Address - Country:US
Practice Address - Phone:307-316-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies