Healthcare Provider Details

I. General information

NPI: 1295229417
Provider Name (Legal Business Name): TARI-ANN YATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 ELM ST
BUFFALO NY
14203-1104
US

IV. Provider business mailing address

920 MADISON AVE STE 447
MEMPHIS TN
38103-3438
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-7635
  • Fax: 716-845-8675
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number344237
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number276548
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: