Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 10923 | AL |
NPI | 1043312101 |
---|---|
Provider Name | Bill Yates |
First Address | Jasper, AL 35501 |
Second Address | Jasper, AL 35501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51085092 | BCBS (01) | AL |
C70543 | (02) |