Healthcare Provider Details

I. General information

NPI: 1104297449
Provider Name (Legal Business Name): CECIL GREY YEATTS III AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 02/28/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DESMOND DOSS HEALTH CLINIC - AUDIOLOGY BLDG 687, 1ST FLOOR
SCHOFIELD BARRACKS HI
96876
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8326
  • Fax:
Mailing address:
  • Phone: 808-433-2460
  • Fax: 808-433-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number145.0116325
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD.0000941
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601001048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: