Individual
JACK E YAKISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3822 COLONIAL AVE, ERIE, PA 16506-3826
(814) 833-5653
(814) 838-1153
Mailing address
3822 COLONIAL AVE, ERIE, PA 16506-3826
(814) 833-5653
(814) 838-1153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD027411E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000078754
BSU
PA
01
—
P00280017
RAILROAD MEDICARE
PA
Enumeration date
10/27/2005
Last updated
10/08/2020
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