Healthcare Provider Details

I. General information

NPI: 1013920875
Provider Name (Legal Business Name): WILLIAM TODD YATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

4864 JACKSON ST
MONROE LA
71202-6400
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7626
  • Fax: 318-330-7648
Mailing address:
  • Phone: 318-330-7626
  • Fax: 318-330-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15172R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15172R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: