Provider Demographics
NPI:1699720714
Name:YANKOW, SANFORD LEE (MD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:LEE
Last Name:YANKOW
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 1:12127B HWY 14 N STE 5
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9499
Mailing Address - Country:US
Mailing Address - Phone:505-286-2396
Mailing Address - Fax:505-286-2398
Practice Address - Street 1:1851 OLD US 66
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6784
Practice Address - Country:US
Practice Address - Phone:505-286-2396
Practice Address - Fax:505-286-2398
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0017585207VG0400X
NM93-435207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59796Medicare UPIN