Provider Demographics
NPI:1851031231
Name:YEAGER, PETER JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JONATHAN
Last Name:YEAGER
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 1:1500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4941
Mailing Address - Country:US
Mailing Address - Phone:817-702-1244
Mailing Address - Fax:
Practice Address - Street 1:1323 E MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1960
Practice Address - Country:US
Practice Address - Phone:419-462-3485
Practice Address - Fax:419-563-0300
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.153472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine