Provider Demographics
NPI:1164436168
Name:YETTER, CRAIG S (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:YETTER
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 1:2203 W LAMPASAS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5668
Mailing Address - Country:US
Mailing Address - Phone:972-875-8833
Mailing Address - Fax:972-875-8866
Practice Address - Street 1:2203 W LAMPASAS ST STE 202
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5668
Practice Address - Country:US
Practice Address - Phone:972-875-8833
Practice Address - Fax:972-875-8866
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2916207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137977817Medicaid
TX8F3940Medicare PIN
TX137977817Medicaid