Healthcare Provider Details

I. General information

NPI: 1053419242
Provider Name (Legal Business Name): WILLIAM L YEATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ASH ST
DOVER NH
03820-3026
US

IV. Provider business mailing address

PO BOX 983
DOVER NH
03821-0983
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-6532
  • Fax:
Mailing address:
  • Phone: 603-749-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG60681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: