Provider Demographics
NPI:1578561973
Name:YEATES, HARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:YEATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36500 EMERALD COAST PKWY
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4713
Practice Address - Country:US
Practice Address - Phone:850-837-0032
Practice Address - Fax:850-278-3826
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69968207Q00000X
FLME122139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00125647OtherRAILROAD MEDICARE
CAG22580Medicare UPIN
CA00A699680Medicare PIN