Individual
ALEXANDER J YEATS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-2000
(904) 346-0864
Mailing address
PO BOX 11349, DAYTONA BEACH, FL 32120-1349
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME104512
FL
390200000X
Student in an Organized Health Care Education/Training Program
0116018632
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001234400
—
FL
01
—
145NZ
FL BLUE CROSS
—
05
—
218610862A
—
GA
Enumeration date
06/19/2008
Last updated
05/23/2011
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