Basic Information
| Provider Information | |||||||||
| NPI: | 1215237870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YARBROUGH | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | MAIN BUILDING, CLINIC F | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029330895 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | MAIN BUILDING, CLINIC F | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029330895 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2010 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R71954 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | PG168338 | OR | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | 50872 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology |
No ID Information.