Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME47461 | FL |
Y | 2086X0206X | Surgical Oncologist | 35276 | SC |
N | 2086X0206X | Surgical Oncologist | TL35276 | SC |
NPI | 1356358840 |
---|---|
Provider Name | Timothy Yeatman |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 18/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17791 | BLUE CROSS BLUE SHIELD (01) | FL |
352763 | (05) | SC |
370797100 | (05) | FL |
E57615 | (02) | FL |