Provider Demographics
NPI:1992889083
Name:YATSU, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:YATSU
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 1:1303 SAND RUN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4743
Mailing Address - Country:US
Mailing Address - Phone:330-836-1585
Mailing Address - Fax:
Practice Address - Street 1:177 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1738
Practice Address - Country:US
Practice Address - Phone:330-375-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0556643Medicaid
OH0556643Medicaid
OHF43862Medicare UPIN