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NPI Code Detail

MEDICARE: GLENN DAVID YOCUM DPM

MEDICARE: GLENN DAVID YOCUM DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatristPO00000223WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G000105970OTHERWAPTAN
200528OTHERWABLUE CROSS BLUE SHIELD
3YO0026OTHERWAREGENCE BLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174649727
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN DAVID YOCUM DPM
Provider Business Mailing Address
First Line : 5407 17TH AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98107-3818
Country : US
Telephone Number : 206-784-2670
Fax Number : 206-784-1590
Provider Business Practice Location Address
First Line : 5407 17TH AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98107-3818
Country : US
Telephone Number : 206-784-2670
Fax Number : 206-784-1590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 09/02/2015

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