Provider Demographics
NPI:1538351440
Name:YATES, MARISSA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:RENEE
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:7601 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-725-9653
Practice Address - Fax:806-725-9650
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM4988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8KS522OtherBCBS
TX792938OtherMEDICARE
NM32303734Medicaid
TX194514907Medicaid