Healthcare Provider Details

I. General information

NPI: 1346212230
Provider Name (Legal Business Name): WILLIAM A YETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 HAYGOOD RD
VIRGINIA BEACH VA
23455-5351
US

IV. Provider business mailing address

4854 HAYGOOD RD
VIRGINIA BEACH VA
23455-5351
US

V. Phone/Fax

Practice location:
  • Phone: 757-468-0550
  • Fax: 757-468-9992
Mailing address:
  • Phone: 757-468-0550
  • Fax: 757-468-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101041411
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: