Individual
CALEB YEATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, EMERGENCY DEPT., FAIRFAX, VA 22030
(703) 631-1745
Mailing address
4094 MAJESTIC LN STE 298, FAIRFAX, VA 22033-2104
(703) 631-1745
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05640
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00609138
RAILROAD MEDICARE PART B
TX
Enumeration date
06/21/2007
Last updated
09/05/2018
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