Provider Demographics
NPI:1083766075
Name:CHARLES YANES MD PA
Entity Type:Organization
Organization Name:CHARLES YANES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:YANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-668-9678
Mailing Address - Street 1:1533 SUNSET DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5773
Mailing Address - Country:US
Mailing Address - Phone:305-668-9678
Mailing Address - Fax:305-663-7992
Practice Address - Street 1:1533 SUNSET DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5700
Practice Address - Country:US
Practice Address - Phone:305-668-9678
Practice Address - Fax:305-663-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300512700Medicaid
DJ390AMedicare PIN
FLG69913Medicare UPIN