Healthcare Provider Details

I. General information

NPI: 1063607372
Provider Name (Legal Business Name): RICHARD ELWOOD YEATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N JUSTICE ST STE B
HENDERSONVILLE NC
28791-3455
US

IV. Provider business mailing address

709 N JUSTICE ST STE B
HENDERSONVILLE NC
28791-3455
US

V. Phone/Fax

Practice location:
  • Phone: 828-696-1255
  • Fax: 828-696-1257
Mailing address:
  • Phone: 828-696-1255
  • Fax: 828-696-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number141161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: