Healthcare Provider Details

I. General information

NPI: 1356428593
Provider Name (Legal Business Name): ROBERT LEO YUSKAITIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 PLAZA BLANCA
SANTA FE NM
87507
US

IV. Provider business mailing address

PO BOX 160448
MIAMI FL
33116-0448
US

V. Phone/Fax

Practice location:
  • Phone: 239-249-9342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME45601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: