MEDICARE: DR. MICHAEL JUDE YAMBOT M.D.

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	E-9250	AR
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	E-9250	AR

General Provider Information

NPI Number	:	1467893479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JUDE YAMBOT M.D.

Provider Business Mailing Address
First Line	:	1617 N WASHINGTON
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-2046
Country	:	US
Telephone Number	:	870-881-4463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 N WASHINGTON
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-2046
Country	:	US
Telephone Number	:	870-881-4463
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	12/17/2021

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