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General NPI Number Information
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NPI Number | 1295749190
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Entity Type | Organization
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Legal Business Name | CRAIG YETTER, DO, P.A.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 2203 W LAMPASAS ST SUITE 111
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City | ENNIS
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State | TX
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Zip | 75119-5644
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Country | US
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Telephone | 972-875-2424
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Fax | 972-875-1244
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Provider Business Mailing Address
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Address Line | 2203 W LAMPASAS ST SUITE 111
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City | ENNIS
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State | TX
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Zip | 75119-5644
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Country | US
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Telephone | 972-875-2424
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Fax | 972-875-1244
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Authorized Official
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Title or Position | MEMBER
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Name | CRAIG S. YETTER
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Credential | DO
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Telephone | 972-875-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H2916
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License Number State | TX
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