Provider Demographics
NPI:1245328012
Name:YOOST, TIMOTHY R (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:YOOST
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 1:2483 HIGHWAY 644
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9242
Mailing Address - Country:US
Mailing Address - Phone:606-638-7488
Mailing Address - Fax:606-638-7345
Practice Address - Street 1:2483 HIGHWAY 644
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9242
Practice Address - Country:US
Practice Address - Phone:606-638-7488
Practice Address - Fax:606-638-7345
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL28010208800000X
IN01067867A208800000X
KY43432208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43432OtherMEDICAL LICENSE
KY7100123030Medicaid
KY7100123030Medicaid