Provider Demographics
NPI:1134109986
Name:YATES, GAYLAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLAN
Middle Name:D
Last Name:YATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0114
Mailing Address - Country:US
Mailing Address - Phone:405-329-2390
Mailing Address - Fax:405-329-0486
Practice Address - Street 1:14101 PARKWAY COMMONS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6012
Practice Address - Country:US
Practice Address - Phone:405-749-2766
Practice Address - Fax:405-749-6203
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35432Medicare UPIN