MEDICARE: DR. BRETON ADAM OREL YATES 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	207ND0101X	MOHS-Micrographic Surgery Physician	10158735-1205	UT

General Provider Information

NPI Number	:	1710242235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETON ADAM OREL YATES M.D.

Provider Business Mailing Address
First Line	:	1548 E 4500 S
Second Line	:	STE 202
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5209
Country	:	US
Telephone Number	:	801-679-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 E 4500 S
Second Line	:	STE 202
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5209
Country	:	US
Telephone Number	:	801-679-4600
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	05/08/2017

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