Provider Demographics
NPI:1982621603
Name:YEN, PAULO RT (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAULO
Middle Name:RT
Last Name:YEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4598
Mailing Address - Country:US
Mailing Address - Phone:931-648-9852
Mailing Address - Fax:931-906-8528
Practice Address - Street 1:1735 HAYNES ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4598
Practice Address - Country:US
Practice Address - Phone:931-648-9852
Practice Address - Fax:931-906-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM336213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00310705OtherRAILROAD MEDICARE
TN3351486Medicaid
TN4109056OtherBC/BS
3351486Medicare ID - Type Unspecified
TNP00310705OtherRAILROAD MEDICARE
TN5500750001Medicare NSC