Provider Demographics
NPI:1265763643
Name:YEZER, ADAM T (RD/LDN CSSD)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:T
Last Name:YEZER
Suffix:
Gender:M
Credentials:RD/LDN CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 GILMAN LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2486
Mailing Address - Country:US
Mailing Address - Phone:919-793-6146
Mailing Address - Fax:919-327-2845
Practice Address - Street 1:330 GILMAN LN
Practice Address - Street 2:SUITE 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2486
Practice Address - Country:US
Practice Address - Phone:919-793-6146
Practice Address - Fax:919-327-2845
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002986133NN1002X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education