Healthcare Provider Details

I. General information

NPI: 1457395691
Provider Name (Legal Business Name): EDUARDO P YABUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 3RD ST NW
JAMESTOWN ND
58401-2968
US

IV. Provider business mailing address

520 3RD ST NW PO BOX 2055
JAMESTOWN ND
58402-2055
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-6300
  • Fax: 701-253-6400
Mailing address:
  • Phone: 701-253-6300
  • Fax: 701-253-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9005
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: