Individual
DR. JONATHAN DAVID YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
2111 COLLEGE AVE, BLUEFIELD, VA 24605-2002
(276) 322-4661
(276) 322-4663
Mailing address
2111 COLLEGE AVE, BLUEFIELD, VA 24605-2002
(276) 322-4661
(276) 322-4663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102202903
VA
207Q00000X
Family Medicine Physician
2379
WV
207Q00000X
Family Medicine Physician
OS-010723L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001798368-003
—
PA
05
—
3810014603
—
WV
Enumeration date
06/16/2006
Last updated
04/06/2015
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