Healthcare Provider Details

I. General information

NPI: 1326781832
Provider Name (Legal Business Name): BRYCE YAMAT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 3RD ST
NEWPORT KY
41071-1814
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-0175
  • Fax: 859-441-3698
Mailing address:
  • Phone: 859-212-0175
  • Fax: 859-441-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberTS970606
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number296409
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: