Provider Demographics
NPI:1871539742
Name:YEARY, EDWIN CURTIS II (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CURTIS
Last Name:YEARY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:STE 606
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-748-7676
Mailing Address - Fax:918-293-3130
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:STE 606
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7676
Practice Address - Fax:918-293-3130
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12655208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK020002100OtherRAILROAD MEDICARE
OK100100460AMedicaid
OK730768966006OtherBLUE CROSS BLUE SHIELD
OKD42951Medicare UPIN
OK$$$$$$$$$Medicare PIN