Provider Demographics
NPI:1124152178
Name:YUKL, RICHARD LESTER (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESTER
Last Name:YUKL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1159
Mailing Address - Country:US
Mailing Address - Phone:909-796-6472
Mailing Address - Fax:909-796-6472
Practice Address - Street 1:24382 LAWTON AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3338
Practice Address - Country:US
Practice Address - Phone:909-796-6472
Practice Address - Fax:909-796-6472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87341208600000X
IA35878208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01214592Medicaid
CO01214592Medicaid
COE4118Medicare ID - Type Unspecified