MEDICARE: YVETTE M MCQUEEN 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	ME83280	FL
2	207P00000X	Emergency Medicine Physician	4301072139	MI
3	207P00000X	Emergency Medicine Physician	01070962A	IN
4	207P00000X	Emergency Medicine Physician	2008026698	MO
5	207P00000X	Emergency Medicine Physician	0101243606	VA
6	207P00000X	Emergency Medicine Physician	62749	GA
7	207P00000X	Emergency Medicine Physician	MD041883	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03878	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891760088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE M MCQUEEN M.D.

Provider Business Mailing Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 15324
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-382-6907
Fax Number	:	904-268-3259

Provider Business Practice Location Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 15324
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-382-6907
Fax Number	:	904-268-3259

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	04/10/2016

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