Provider Demographics
NPI:1124072590
Name:YEAGER, DAVID R (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:YEAGER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5337
Practice Address - Street 1:210 E GRAY ST STE 900
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3905
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-584-6851
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA871363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00180962OtherRAILROAD MEDICARE
KYP00825792OtherRAILROAD MEDICARE
KY000000352158OtherANTHEM
KY000028412ZOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY95004982Medicaid
N302048OtherHARMONY
KY2447386000OtherPASSPORT ADVANTAGE
KY50006104OtherPASSPORT
KY50024958OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
KY3728034000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY000000628581OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KYP00825792OtherRAILROAD MEDICARE
KY000000628581OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY000028412ZOtherHUMANA- NORTON LEATHERMAN SPINE CENTER