Provider Demographics
NPI:1174585160
Name:YEAGER, LAUREL ANN (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:YEAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ANN
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 JUNGERMANN CIRCLE
Mailing Address - Street 2:STE 205
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-2122
Mailing Address - Fax:636-441-5290
Practice Address - Street 1:6 JUNGERMANN CIRCLE
Practice Address - Street 2:STE 205
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-441-2122
Practice Address - Fax:636-441-5290
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD118120208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020042114OtherRAILROAD MEDICARE
106160OtherBLUE CHOICE
MO203970009Medicaid
5887470OtherAETNA
6190929001OtherCIGNA
106160OtherBLUE CROSS BLUE SHIELD
11515OtherESSENCE
330937OtherHEALTHLINK
430910980001OtherPRUDENTIAL
23124V2907OtherGHP
BLC38C83OtherBLUE CHOICE
M6725OtherMEDICARE ARKANSAS
017231OtherEXCLUSIVE CHOICE
1093359OtherCARE PARTNER
G48912OtherMERCY
1708450OtherUNITED HEALTHCARE
23124V2907OtherGHP
430910980001OtherPRUDENTIAL