Provider Demographics
NPI:1396124475
Name:YATES, DOUGLAS BRYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRYAN
Last Name:YATES
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:950 HIGHWAY 879
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-7109
Mailing Address - Country:US
Mailing Address - Phone:318-547-9579
Mailing Address - Fax:
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER
Practice Address - City:JBSA FSH
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:318-547-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2021-08-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant