Provider Demographics
NPI:1366607624
Name:YEPES, FERNANDO A (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:YEPES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2958
Mailing Address - Country:US
Mailing Address - Phone:308-865-7990
Mailing Address - Fax:
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2958
Practice Address - Country:US
Practice Address - Phone:308-865-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27340207LC0200X
NETEP5886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301100Medicaid