Provider Demographics
NPI:1063513828
Name:F.E. YUZON, M.D. INC
Entity type:Organization
Organization Name:F.E. YUZON, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEKOTA
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:440-233-1003
Mailing Address - Street 1:3885 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2842
Mailing Address - Country:US
Mailing Address - Phone:440-282-5100
Mailing Address - Fax:440-282-1302
Practice Address - Street 1:3885 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2842
Practice Address - Country:US
Practice Address - Phone:440-282-5100
Practice Address - Fax:440-282-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035173207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9153751Medicare PIN