Healthcare Provider Details

I. General information

NPI: 1255307807
Provider Name (Legal Business Name): PHILIP R YEARIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 BRIDGEPORT WAY W SUITE 201
LAKEWOOD WA
98499-8000
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 253-582-7257
  • Fax: 253-582-1617
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP000000535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: