Basic Information
| Provider Information | |||||||||
| NPI: | 1376651240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YALE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 NW 9TH BLVD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523336680 | ||||||||
| FaxNumber: | 3523314006 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 NW 9TH BLVD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523336680 | ||||||||
| FaxNumber: | 3523314006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 41033 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME121562 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32544400 | 05 | WI | MEDICAID |