Provider Demographics
NPI:1205825619
Name:YOB, EDWARD HENRY (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:HENRY
Last Name:YOB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7550
Mailing Address - Country:US
Mailing Address - Phone:918-307-0215
Mailing Address - Fax:918-250-7669
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7550
Practice Address - Country:US
Practice Address - Phone:918-307-0215
Practice Address - Fax:918-250-7669
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2842207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100025020AMedicaid
OK070015931OtherRAILROAD MEDICARE
OK070015931OtherRAILROAD MEDICARE
E72577Medicare UPIN