Provider Demographics
NPI:1073557047
Name:YATES, JONATHAN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:YATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2002
Mailing Address - Country:US
Mailing Address - Phone:276-322-4661
Mailing Address - Fax:276-322-4663
Practice Address - Street 1:2111 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2002
Practice Address - Country:US
Practice Address - Phone:276-322-4661
Practice Address - Fax:276-322-4663
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010723L207Q00000X
WV2379207Q00000X
VA0102202903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810014603Medicaid
PA001798368-003Medicaid
G86534Medicare UPIN
WV4302381Medicare PIN
PA001798368-003Medicaid