Basic Information
| Provider Information | |||||||||
| NPI: | 1255379079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORKGITIS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100108 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522735670 | ||||||||
| FaxNumber: | 3522735683 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 N CLYDE MORRIS BLVD STE 510 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862411020 | ||||||||
| FaxNumber: | 3862411022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OT013129 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 257973 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | OS13802 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 363A00000X | MA051179 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | COOO2694 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 208600000X | OS13802 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 017421600 | 05 | FL | MEDICAID |