Provider Demographics
NPI:1427048875
Name:YAEGER, CARL F (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:YAEGER
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 1:18399 CORRAL DEL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:CORRAL DE TIERRA
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9197
Mailing Address - Country:US
Mailing Address - Phone:831-484-2484
Mailing Address - Fax:831-484-2484
Practice Address - Street 1:18399 CORRAL DEL CIELO RD
Practice Address - Street 2:
Practice Address - City:CORRAL DE TIERRA
Practice Address - State:CA
Practice Address - Zip Code:93908-9197
Practice Address - Country:US
Practice Address - Phone:831-484-2484
Practice Address - Fax:831-484-2484
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA241332080N0001X
KY387222080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2310109Medicaid
WV3810007736Medicaid
1427048875OtherFEDERAL NPI NUMBER
CA00A241330Medicaid
OH2705184Medicaid
KY64107204Medicaid
OH2705184Medicaid
OR2310109Medicaid