Provider Demographics
NPI:1215936612
Name:YUNKER, PHILLIP HARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HARRELL
Last Name:YUNKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 W MCDONALD PKWY
Mailing Address - Street 2:STE 1-C
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1164
Mailing Address - Country:US
Mailing Address - Phone:606-564-9081
Mailing Address - Fax:606-564-9083
Practice Address - Street 1:1 W MCDONALD PKWY
Practice Address - Street 2:STE 1-C
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1164
Practice Address - Country:US
Practice Address - Phone:606-564-9081
Practice Address - Fax:606-564-9083
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045906OtherANTHEM BC/BS PROVIDER #
KY610902583OtherUNITED HLTHCARE #
KY610902583OtherFEDERAL TAX ID #
KY64168370OtherKY MEDICAID NUMBER
KY1182199OtherCHA PROVIDER #
OH0315859OtherOHIO MEDICAID PROVIDER #
KYC69681Medicare UPIN
KY1058501Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER