Provider Demographics
NPI:1336221613
Name:YEATER, REED L (MD)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:L
Last Name:YEATER
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:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-883-5541
Mailing Address - Fax:406-883-3193
Practice Address - Street 1:5 4TH AVE EAST
Practice Address - Street 2:
Practice Address - City:POISON
Practice Address - State:MT
Practice Address - Zip Code:59860
Practice Address - Country:US
Practice Address - Phone:406-883-5541
Practice Address - Fax:406-883-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057039208D00000X
MT11272208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057039Medicaid
C38125Medicare UPIN
C38135Medicare UPIN
IL080064879 / CA4079Medicare ID - Type UnspecifiedRR
IL815980Medicare ID - Type UnspecifiedGROUP #
IL036057039Medicaid