Provider Demographics
NPI:1083795215
Name:YATES, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 CLEARWATER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7180
Mailing Address - Country:US
Mailing Address - Phone:928-771-0555
Mailing Address - Fax:928-771-0444
Practice Address - Street 1:3101 CLEARWATER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7180
Practice Address - Country:US
Practice Address - Phone:928-771-0555
Practice Address - Fax:928-771-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23760207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE14847Medicare UPIN
AZZ63477Medicare PIN