Provider Demographics
NPI:1629276845
Name:DR BILL YATES MD PC
Entity Type:Organization
Organization Name:DR BILL YATES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-384-3481
Mailing Address - Street 1:203 19TH ST E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5457
Mailing Address - Country:US
Mailing Address - Phone:205-384-3481
Mailing Address - Fax:205-384-1057
Practice Address - Street 1:203 19TH ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5457
Practice Address - Country:US
Practice Address - Phone:205-384-3481
Practice Address - Fax:205-384-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10923208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529302220Medicaid
AL51085092OtherBLUE CROSS & BLUE SHIELD
ALC70543Medicare UPIN
AL529302220Medicaid