Healthcare Provider Details

I. General information

NPI: 1699720714
Provider Name (Legal Business Name): SANFORD LEE YANKOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD US 66
EDGEWOOD NM
87015-6784
US

IV. Provider business mailing address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-2396
  • Fax: 505-286-2398
Mailing address:
  • Phone: 505-286-2396
  • Fax: 505-286-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0017585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93-435
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number93-435
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: