Provider Demographics
NPI:1356488993
Name:NATHANIEL T. YOKUBAITIS, M.D., P.A.
Entity Type:Organization
Organization Name:NATHANIEL T. YOKUBAITIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:YOKUBAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-964-2950
Mailing Address - Street 1:3608 PRESTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8654
Mailing Address - Country:US
Mailing Address - Phone:972-964-2950
Mailing Address - Fax:972-852-7962
Practice Address - Street 1:3608 PRESTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8654
Practice Address - Country:US
Practice Address - Phone:972-964-2950
Practice Address - Fax:972-852-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972727097OtherTYPE I NPI
H52668Medicare UPIN
00992RMedicare ID - Type Unspecified