MEDICARE: TRAVIS YATES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	9830	MS

General Provider Information

NPI Number	:	1003853045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS YATES DO

Provider Business Mailing Address
First Line	:	701 QUIET VALLEY CV
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-8430
Country	:	US
Telephone Number	:	662-234-1881
Fax Number	:

Provider Business Practice Location Address
First Line	:	REBEL DRIVE
Second Line	:	STUDENT HEALTH CENTER
City	:	UNIVERSITY
State	:	MS
Zip	:	38677
Country	:	US
Telephone Number	:	662-915-7274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/24/2008

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