Provider Demographics
NPI:1063594190
Name:YEE, WAYNE W (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:W
Last Name:YEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3900 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3201
Practice Address - Country:US
Practice Address - Phone:817-237-7161
Practice Address - Fax:817-237-0966
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX916858OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX114462801Medicaid
TX4062470OtherAETNA PIN
TX86W432OtherBCBSTX IND PIN
TX140442881Medicaid
TX148299100OtherFIRSTCARE PIN
TX1134979OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX137345804Medicaid
TXYEEWC23855OtherCCHIP PIN
TX4062470OtherAETNA PIN
TX140442881Medicaid
TX86W432Medicare PIN