Healthcare Provider Details

I. General information

NPI: 1366062390
Provider Name (Legal Business Name): JEVIN YABUT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 08/25/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOUCHER ST
NEW ORLEANS LA
70115-3515
US

IV. Provider business mailing address

433 BOLIVAR ST
NEW ORLEANS LA
70112-7021
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-7011
  • Fax:
Mailing address:
  • Phone: 504-568-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number340665
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340665
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: