Provider Demographics
NPI:1538157540
Name:YATES, MATTHEW M (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:M
Last Name:YATES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 RYAN CIR
Mailing Address - Street 2:
Mailing Address - City:UINTAH
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7321 11TH ST
Practice Address - Street 2:75 MDG / SGOPF
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5012
Practice Address - Country:US
Practice Address - Phone:801-586-9710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1053660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant