Basic Information
Provider Information | |||||||||
NPI: | 1134476732 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YEARY | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | GEORGE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 AIRPORT GARDENS RD | ||||||||
Address2: |   | ||||||||
City: | HAZARD | ||||||||
State: | KY | ||||||||
PostalCode: | 417019529 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6064396978 | ||||||||
FaxNumber: | 6064396927 | ||||||||
Practice Location | |||||||||
Address1: | 200 MEDICAL CENTER DRIVE | ||||||||
Address2: |   | ||||||||
City: | HAZARD | ||||||||
State: | KY | ||||||||
PostalCode: | 41701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6064396782 | ||||||||
FaxNumber: | 6064396879 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/14/2012 | ||||||||
LastUpdateDate: | 06/04/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 5315056802 | MI | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208600000X | TP475 | KY | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.