Provider Demographics
NPI:1548268444
Name:YEATTS, LINDA E (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:YEATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 N INTERSTATE 35
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3432
Mailing Address - Country:US
Mailing Address - Phone:940-566-3700
Mailing Address - Fax:940-566-3774
Practice Address - Street 1:4401 N INTERSTATE 35
Practice Address - Street 2:SUITE 209
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3432
Practice Address - Country:US
Practice Address - Phone:940-566-3700
Practice Address - Fax:940-566-3774
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114677101Medicaid
TX114677104Medicaid
TXH5101OtherSTATE
TX8J9496Medicare PIN
TXB67630Medicare UPIN
TX114677101Medicaid