Individual
PROF. JEFFREY GERALD YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPA, PA-C
Contact information
Practice address
825 FAIRFAX AVE, SUITE 610, NORFOLK, VA 23507-1914
(757) 446-8960
(757) 446-5197
Mailing address
PO BOX 936, EVMS MEDICAL GROUP, NORFOLK, VA 23501-0936
(757) 446-8960
(757) 446-5197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001689
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-019
TRICARE/CHAMPUS
VA
01
—
10102569P
OPTIMA HEALTH
VA
05
—
1033347570
—
VA
05
—
8103007
—
NC
01
—
PAR
CORVEL
VA
Enumeration date
06/23/2009
Last updated
01/29/2016
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