Provider Demographics
NPI:1295700870
Name:YELTON, BLANE WESLEY JR
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:WESLEY
Last Name:YELTON
Suffix:JR
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 1:211 OLD LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3428
Mailing Address - Country:US
Mailing Address - Phone:336-472-1191
Mailing Address - Fax:336-472-1208
Practice Address - Street 1:211 OLD LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3428
Practice Address - Country:US
Practice Address - Phone:336-472-1191
Practice Address - Fax:336-472-1208
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17459207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989693Medicaid
NCC87318Medicare UPIN
NC8989693Medicaid
NC211752PMedicare PIN