Healthcare Provider Details

I. General information

NPI: 1659908515
Provider Name (Legal Business Name): SETH ALLEN YATES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SHARON RD STE D
CIRCLEVILLE OH
43113-1498
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-420-8422
  • Fax: 740-420-6270
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: