Provider Demographics
NPI:1972727097
Name:YOKUBAITIS, NATHANIEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:THOMAS
Last Name:YOKUBAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 PRESTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8654
Mailing Address - Country:US
Mailing Address - Phone:972-964-2950
Mailing Address - Fax:972-852-7962
Practice Address - Street 1:3608 PRESTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8654
Practice Address - Country:US
Practice Address - Phone:972-964-2950
Practice Address - Fax:972-852-7962
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356488993OtherTYPE II NPI
TX1356488993OtherTYPE II NPI
TXH52668Medicare UPIN