Provider Demographics
NPI:1851397780
Name:YATES, LEROY L (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:L
Last Name:YATES
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 1:3170 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3864
Mailing Address - Country:US
Mailing Address - Phone:563-275-4701
Mailing Address - Fax:
Practice Address - Street 1:3170 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3864
Practice Address - Country:US
Practice Address - Phone:563-275-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
075592OtherHEALTH ALLIANCE
IA1064535Medicaid
47368OtherWELLMARK HEALTH PLANS
IL525525902Medicaid
IA01C2OtherJOHN DEERE HEALTH PLAN
4796890005OtherDMERC
202030OtherIOWA HEALTH SOLUTIONS
075592OtherHEALTH ALLIANCE
47368OtherWELLMARK HEALTH PLANS
202030OtherIOWA HEALTH SOLUTIONS