MEDICARE: DR. BRYAN D YATES MD

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	2084P0800X	Psychiatry Physician	MD21708	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548279102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN D YATES MD

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	833-299-8415

Provider Business Practice Location Address
First Line	:	621 W MADRONE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3090
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	833-299-8415

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/24/2021

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