1740217116 NPI number — WOODROW W YEANEY III M.D.

Table of content: WOODROW W YEANEY III M.D. (NPI 1740217116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740217116 NPI number — WOODROW W YEANEY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEANEY
Provider First Name:
WOODROW
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.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:
1740217116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4502 CORTEZ RD W
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34210-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-286-0033
Provider Business Mailing Address Fax Number:
813-489-2537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4502 CORTEZ RD W FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34210-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-243-3991
Provider Business Practice Location Address Fax Number:
941-243-3953
Provider Enumeration Date:
06/28/2006

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: 2086S0129X , with the licence number:  200401453 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276615900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022439400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".