Provider Demographics
NPI:1366686842
Name:YATES, STEVEN BRANDON (IDMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRANDON
Last Name:YATES
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 E ARCADIA AVE BLDG 622
Mailing Address - Street 2:27TH SOSS/OSM
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5112
Mailing Address - Country:US
Mailing Address - Phone:575-784-0283
Mailing Address - Fax:
Practice Address - Street 1:208 W CASABLANCA AVE
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5009
Practice Address - Country:US
Practice Address - Phone:575-784-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians