Individual
SUZANNE M YANDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 MARIO CAPECCHI DR, 4550, SALT LAKE CITY, UT 84113-1103
(801) 662-5600
Mailing address
PO BOX 413026, SALT LAKE CITY, UT 84141-3026
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
M8442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000101-01
—
TX
01
—
2000101-02
MEDICAID CSHCN - AUSTIN
TX
05
—
2000101-03
—
TX
01
—
2000101-04
MEDICAID CSHCN - ROT
TX
05
—
200010105
—
TX
01
—
8CS727
BCBS
TX
01
—
8V1731
BCBSTX INDIVIDUAL NUMBER
TX
Enumeration date
01/11/2008
Last updated
11/26/2013
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