Basic Information
| Provider Information | |||||||||
| NPI: | 1427067842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANCEY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 205 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302663 | ||||||||
| FaxNumber: | 2535302675 | ||||||||
| Practice Location | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | STE 205 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302663 | ||||||||
| FaxNumber: | 2535302675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD00021802 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8235798 | 05 | WA | MEDICAID | 0201041 | 01 | WA | STATE L&I | OTHER | P00258933 | 01 | WA | MEDICARE RAILROAD | OTHER | 8906805 | 01 | WA | STATE CRIME VICTIMS | OTHER |