Provider Demographics
NPI:1538461421
Name:KUEBERUWA YATES, ESSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ESSIE
Middle Name:
Last Name:KUEBERUWA YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESSIE
Other - Middle Name:
Other - Last Name:KUEBERUWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:407 SE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3915
Mailing Address - Country:US
Mailing Address - Phone:954-463-5208
Mailing Address - Fax:954-463-5288
Practice Address - Street 1:407 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3915
Practice Address - Country:US
Practice Address - Phone:954-463-5208
Practice Address - Fax:954-463-5288
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250575932086S0122X
FLME126632208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery