Individual
TIMOTHY YAZZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1134 N 500 W, SUITE 102, PROVO, UT 84604-3383
(801) 357-1770
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 375-1770
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
18-2006
NM
207Q00000X
Family Medicine Physician
Primary
331777-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04452755
—
NM
05
—
253562
—
AZ
05
—
33732361
—
CO
Enumeration date
02/06/2007
Last updated
06/27/2022
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