Provider Demographics
NPI:1568448801
Name:YAMADA, WESLEY NEIL (DPM)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:NEIL
Last Name:YAMADA
Suffix:
Gender:M
Credentials:DPM
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 38
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147
Mailing Address - Country:US
Mailing Address - Phone:602-528-1258
Mailing Address - Fax:602-528-1255
Practice Address - Street 1:483 W SEED FARM ROAD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0381213E00000X, 213ES0103X
CAEFE3362213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0381OtherAZ PODIATRY LICENSE #
CAEFE3362OtherCA LICENSE #
CABH4706238OtherDEA #
CABH4706238OtherDEA #
CAT11653Medicare UPIN
AZT111653Medicare UPIN