Provider Demographics
NPI:1083231161
Name:YATES, ANDREW J (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:YATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IRELAND ARMY HEALTH CLINIC
Mailing Address - Street 2:200 BRULE STREET
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121
Mailing Address - Country:US
Mailing Address - Phone:502-624-9928
Mailing Address - Fax:
Practice Address - Street 1:IRELAND ARMY HEALTH CLINIC
Practice Address - Street 2:200 BRULE STREET
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:026-249-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64382171000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider