MEDICARE: GEORGE DANIEL YATZKAN MD

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	207R00000X	Internal Medicine Physician	ME77088	FL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME77088	FL
3	207RP1001X	Pulmonary Disease Physician	ME77088	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00306540	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	255428300	OTHER	FL	PSN
4	N230893	OTHER	FL	WELLCARE
5	44965	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457308744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE DANIEL YATZKAN MD

Provider Business Mailing Address
First Line	:	PO BOX 266211
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-6211
Country	:	US
Telephone Number	:	561-967-4118
Fax Number	:	561-967-3463

Provider Business Practice Location Address
First Line	:	11750 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3530
Country	:	US
Telephone Number	:	305-223-3000
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	10/09/2013

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