Healthcare Provider Details

I. General information

NPI: 1154357127
Provider Name (Legal Business Name): YANCY MARC BELLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 116TH AVE NE
BELLEVUE WA
98004-4604
US

IV. Provider business mailing address

PO BOX 34960
SEATTLE WA
98124-1960
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5000
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00042265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: