1104297449 NPI number — DR. CECIL GREY YEATTS III AU.D.

Table of content: DR. CECIL GREY YEATTS III AU.D. (NPI 1104297449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104297449 NPI number — DR. CECIL GREY YEATTS III AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEATTS
Provider First Name:
CECIL
Provider Middle Name:
GREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
AU.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104297449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRIPLER AMC
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-2460
Provider Business Mailing Address Fax Number:
808-433-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DESMOND DOSS HEALTH CLINIC - AUDIOLOGY
Provider Second Line Business Practice Location Address:
BLDG 687, 1ST FLOOR
Provider Business Practice Location Address City Name:
SCHOFIELD BARRACKS
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-8326
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  145.0116325 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AUD.0000941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1601001048 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)