Provider Demographics
NPI:1285621482
Name:YODER, LEON JAY (DO)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:JAY
Last Name:YODER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4624
Mailing Address - Country:US
Mailing Address - Phone:918-485-1205
Mailing Address - Fax:
Practice Address - Street 1:1202 W CHEROKEE ST STE C
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-4629
Practice Address - Country:US
Practice Address - Phone:918-485-1205
Practice Address - Fax:918-485-1695
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1728207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD70473Medicare UPIN