Basic Information
| Provider Information | |||||||||
| NPI: | 1598702359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YATES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W NORTHWOOD ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362750927 | ||||||||
| FaxNumber: | 3362754834 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362750927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 32603 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200032531 | 01 | NC | RAILROAD MEICARE | OTHER | 7989683 | 05 | NC | MEDICAID |