Provider Demographics
NPI:1376512624
Name:YAMOUR, BEVERLY JEAN (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEAN
Last Name:YAMOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-2197
Mailing Address - Country:US
Mailing Address - Phone:740-333-7296
Mailing Address - Fax:740-333-7866
Practice Address - Street 1:4 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2197
Practice Address - Country:US
Practice Address - Phone:740-333-7296
Practice Address - Fax:740-333-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047532Y207R00000X, 207RC0000X
OH35.047532208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489314Medicaid
OH0489314Medicaid
OHH025971Medicare PIN