Provider Demographics
NPI:1316970270
Name:YATES, JUDY LYN (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYN
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SCRIPTURE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2314
Mailing Address - Country:US
Mailing Address - Phone:940-387-7441
Mailing Address - Fax:
Practice Address - Street 1:2501 SCRIPTURE ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2314
Practice Address - Country:US
Practice Address - Phone:940-387-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038579102Medicaid
TX110224931OtherRR MEDICARE
TX8B5301OtherBCBS
TX038579103Medicaid
TX038579105Medicaid
TX038579104Medicaid
TX8L1789Medicare PIN
TX8990M1Medicare ID - Type Unspecified
TX8B5301OtherBCBS
H21911Medicare UPIN
TX038579103Medicaid