Provider Demographics
NPI:1821097197
Name:YELTATZIE, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:YELTATZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:ALLEN
Other - Last Name:YELTATZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2925 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2271
Mailing Address - Country:US
Mailing Address - Phone:563-264-2222
Mailing Address - Fax:563-264-8076
Practice Address - Street 1:2925 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2271
Practice Address - Country:US
Practice Address - Phone:563-264-2222
Practice Address - Fax:563-264-8076
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA267102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAD89629Medicare UPIN
IA03164Medicare ID - Type Unspecified