| Doctor Name: | DR. ERNESTO T. YUTIAMCO |
| NPI Number: | 1942219365 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 13306 |
| Business Practice Address: | 483 Main St Madison, WV - 251301223 |
| Business Phone Number: | 3043690221 |
| Business Fax Number: | 3043690222 |
| Mailing Address: | Po Box 428, MADISON |
| State: | WV |
| Postal Code: | 251300428 |
| Phone Number: | 3043690221 |
| Fax Number: | 3043690222 |
| NPI Enumeration Date: | 08/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 13306 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |