Provider Demographics
NPI:1134261225
Name:IRISH, YELIU (LMT)
Entity type:Individual
Prefix:
First Name:YELIU
Middle Name:
Last Name:IRISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 HWY389
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0000
Mailing Address - Country:US
Mailing Address - Phone:850-747-1444
Mailing Address - Fax:850-747-1444
Practice Address - Street 1:2195 JENKS AVE STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4551
Practice Address - Country:US
Practice Address - Phone:850-747-1444
Practice Address - Fax:850-747-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist