1568434819 NPI number — DR. JOHN M YALAM M.D.

Table of content: DR. JOHN M YALAM M.D. (NPI 1568434819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568434819 NPI number — DR. JOHN M YALAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YALAM
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568434819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 E CAMELBACK RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85014-5095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-264-9100
Provider Business Mailing Address Fax Number:
602-264-9101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9755 N 90TH ST
Provider Second Line Business Practice Location Address:
SUITE A205
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-614-2215
Provider Business Practice Location Address Fax Number:
480-614-2218
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  24488 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 558562 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120390 . This is a "GROUP MEDICARE NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 317047 . This is a "GROUP MEDICAID NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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