Provider Demographics
NPI:1811939176
Name:YEAGER-SMITH, LORA D (DPM)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:D
Last Name:YEAGER-SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W EL NORTE PKWY APT 35
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3356
Mailing Address - Country:US
Mailing Address - Phone:951-396-1538
Mailing Address - Fax:
Practice Address - Street 1:1051 W EL NORTE PKWY APT 35
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3356
Practice Address - Country:US
Practice Address - Phone:951-396-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL161213ES0131X
CAE5822213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51046369OtherBCBS PROVIDER NUMBER
AL000046369Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL51046369OtherBCBS PROVIDER NUMBER