Provider Demographics
NPI:1780779991
Name:YODER, PAUL T (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:YODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-6601
Mailing Address - Country:US
Mailing Address - Phone:928-363-1173
Mailing Address - Fax:928-363-1173
Practice Address - Street 1:904 N OVERLOOK CIR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-6601
Practice Address - Country:US
Practice Address - Phone:928-363-1173
Practice Address - Fax:928-363-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0735560OtherBLUE CROSS
C24695Medicare UPIN
AZZ76347Medicare PIN