Provider Demographics
NPI:1700840667
Name:YANT, ROBERT D (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:YANT
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-251-5053
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:1914 SOUTHSIDE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1930
Practice Address - Country:US
Practice Address - Phone:904-726-9901
Practice Address - Fax:904-726-9987
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-07-01
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Provider Licenses
StateLicense IDTaxonomies
FLPO1121213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
87606ZMedicare PIN
FLT88549Medicare UPIN
21698DMedicare PIN
21698CMedicare PIN