Provider Demographics
NPI:1417781758
Name:YERMAN, INDIRA M
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:M
Last Name:YERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-6691
Mailing Address - Country:US
Mailing Address - Phone:530-801-1374
Mailing Address - Fax:
Practice Address - Street 1:1151 N ADAIR ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-8900
Practice Address - Country:US
Practice Address - Phone:503-359-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA222181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine