Provider Demographics
NPI:1922158799
Name:YATSU, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:YATSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27242
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-2242
Mailing Address - Country:US
Mailing Address - Phone:512-413-3065
Mailing Address - Fax:512-502-1027
Practice Address - Street 1:6417 WILLIAMS RIDGE WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2709
Practice Address - Country:US
Practice Address - Phone:512-413-3065
Practice Address - Fax:512-502-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9020208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine