Healthcare Provider Details

I. General information

NPI: 1740217116
Provider Name (Legal Business Name): WOODROW W YEANEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 CORTEZ RD W FL 2
BRADENTON FL
34210-3143
US

IV. Provider business mailing address

4502 CORTEZ RD W STE 200
BRADENTON FL
34210-3124
US

V. Phone/Fax

Practice location:
  • Phone: 941-243-3991
  • Fax: 941-243-3953
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-489-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number200401453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: