MEDICARE: MR. MATTHEW M YATES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1053660	NE

General Provider Information

NPI Number	:	1538157540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW M YATES PA-C

Provider Business Mailing Address
First Line	:	2007 RYAN CIR
Second Line	:
City	:	UINTAH
State	:	UT
Zip	:	84403-4995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 11TH ST
Second Line	:	75 MDG / SGOPF
City	:	HILL AFB
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-586-9710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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