Healthcare Provider Details

I. General information

NPI: 1225299613
Provider Name (Legal Business Name): ALEXANDER J YEATS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 11349
DAYTONA BEACH FL
32120-1349
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax: 904-346-0864
Mailing address:
  • Phone: 386-274-7800
  • Fax: 386-274-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116018632
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME104512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: