Provider Demographics
NPI:1669911277
Name:GARLAND W. YARBOROUGH M.D S,C
Entity type:Organization
Organization Name:GARLAND W. YARBOROUGH M.D S,C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-207-1058
Mailing Address - Street 1:2500 W LAYTON AVE
Mailing Address - Street 2:SUITE250
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:414-269-9373
Mailing Address - Fax:414-323-7779
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE250
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-269-9373
Practice Address - Fax:414-323-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23313261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty