Provider Demographics
NPI:1215947882
Name:YATTEAU, THOMAS FREDERICK
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FREDERICK
Last Name:YATTEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 HOEN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-9405
Mailing Address - Country:US
Mailing Address - Phone:707-579-1400
Mailing Address - Fax:707-579-1411
Practice Address - Street 1:4725 HOEN AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-9405
Practice Address - Country:US
Practice Address - Phone:707-579-1400
Practice Address - Fax:707-579-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35354OtherCA STATE MEDICAL LICENSE#
AY9448576OtherDEA#
CAA27757Medicare UPIN
CAA35354Medicare ID - Type Unspecified
CAA35354OtherCA STATE MEDICAL LICENSE#