Basic Information
Provider Information
NPI: 1801386321
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YEAGER
FirstName: VIOLET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1065 NE 125TH ST STE 300
Address2:  
City: NORTH MIAMI
State: FL
PostalCode: 331615833
CountryCode: US
TelephoneNumber: 8888526672
FaxNumber: 7862356225
Practice Location
Address1: 7481 W OAKLAND PARK BLVD STE 100
Address2:  
City: TAMARAC
State: FL
PostalCode: 333194985
CountryCode: US
TelephoneNumber: 9547717743
FaxNumber: 9547717748
Other Information
ProviderEnumerationDate: 05/10/2018
LastUpdateDate: 07/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XOS17715FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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