Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7747 | TN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 7747 | TN |
NPI | 1477791689 |
---|---|
Provider Name | Dr. Raymond B Yates |
First Address | Knoxville, TN 37923-1331 |
Second Address | Knoxville, TN 37923-1331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04540 | (02) | LA |