Individual
DR. JOHN THOMAS YETTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
200 HEALTH CARE DR, STE 1501, GREENVILLE, IL 62246-1154
(618) 664-9830
(618) 664-9820
Mailing address
8531 FROST AVE, BERKELEY, MO 63134-1443
(314) 761-1577
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036063187
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036363187
IL LICENSE
IL
01
—
810300008
MEDICARE OSCAR A
IL
01
—
841619029
MISSOURI
MO
Enumeration date
05/04/2006
Last updated
06/30/2009
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