Provider Demographics
NPI:1104145622
Name:YEYKAL, JOSHUA MARK (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
Last Name:YEYKAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 ANSLEY PL
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5208
Mailing Address - Country:US
Mailing Address - Phone:814-860-1989
Mailing Address - Fax:
Practice Address - Street 1:1887 KINGSLEY AVE STE 1900
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4451
Practice Address - Country:US
Practice Address - Phone:904-276-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16261208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery