Provider Demographics
NPI:1245229327
Name:YATES, PATRICE R (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:R
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3834 S EMERSON AVE
Mailing Address - Street 2:BUILDING C STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5902
Mailing Address - Country:US
Mailing Address - Phone:317-782-1577
Mailing Address - Fax:317-780-5539
Practice Address - Street 1:3834 S EMERSON AVE
Practice Address - Street 2:BUILDING C, SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:317-780-5539
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01050757A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110185492OtherRR MEDICARE
IN200225030AMedicaid
IN200225030AMedicaid
IN715320KMedicare PIN