Provider Demographics
NPI:1962563114
Name:YODER, DWIGHT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:ALLEN
Last Name:YODER
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 1:1605 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2960
Mailing Address - Country:US
Mailing Address - Phone:251-660-9393
Mailing Address - Fax:251-662-0372
Practice Address - Street 1:1605 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2960
Practice Address - Country:US
Practice Address - Phone:251-660-9393
Practice Address - Fax:251-662-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517605OtherBCBS OF AL
MS03374772Medicaid
AL51517605OtherBCBS OF AL