Basic Information
| Provider Information | |||||||||
| NPI: | 1538373006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANON-MATOS | ||||||||
| FirstName: | YORELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 SIOUX POINT ROAD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172667 | ||||||||
| FaxNumber: | 6052172900 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 SIOUX POINT ROAD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172667 | ||||||||
| FaxNumber: | 6052172900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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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 | 2086S0105X | MD-42747 | IA | N | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 2086S0105X | 9559 | SD | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | P00946088 | 01 | KY | RAILROAD MEDICARE | OTHER | 7100112280 | 05 | KY | MEDICAID |