Provider Demographics
NPI:1427076595
Name:YEARWOOD, THOMAS LAMAR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAMAR
Last Name:YEARWOOD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1317
Mailing Address - Country:US
Mailing Address - Phone:228-627-5192
Mailing Address - Fax:
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 112A
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-938-0700
Practice Address - Fax:228-938-0705
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15545208VP0014X
MS11988208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-14252OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL051514252Medicare PIN
D91465Medicare UPIN
MS720000007Medicare PIN