Provider Demographics
NPI:1427067842
Name:YANCEY, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:YANCEY
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 1:11511 CANTERWOOD BLVD NW
Mailing Address - Street 2:STE 205
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5818
Mailing Address - Country:US
Mailing Address - Phone:253-530-2663
Mailing Address - Fax:253-530-2675
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:STE 205
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5818
Practice Address - Country:US
Practice Address - Phone:253-530-2663
Practice Address - Fax:253-530-2675
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021802207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8235798Medicaid
WA0201041OtherSTATE L&I
WAP00258933OtherMEDICARE RAILROAD
WA8906805OtherSTATE CRIME VICTIMS
WA8906805OtherSTATE CRIME VICTIMS
E27206Medicare UPIN