Provider Demographics
NPI:1013177971
Name:RUTH A YATES, MD
Entity Type:Organization
Organization Name:RUTH A YATES, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-4401
Mailing Address - Street 1:520 MADISON ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4253
Mailing Address - Country:US
Mailing Address - Phone:256-536-4401
Mailing Address - Fax:256-536-3153
Practice Address - Street 1:520 MADISON ST SE STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4253
Practice Address - Country:US
Practice Address - Phone:256-536-4401
Practice Address - Fax:256-536-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2020-04-24
Deactivation Date:2008-10-01
Deactivation Code:
Reactivation Date:2020-04-24
Provider Licenses
StateLicense IDTaxonomies
AL13786207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084341Medicaid