Healthcare Provider Details

I. General information

NPI: 1083754154
Provider Name (Legal Business Name): THOMAS J. YETMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S QUARTERS 6-7
SEATTLE WA
98144-2712
US

IV. Provider business mailing address

1200 12TH AVE S QUARTERS 6-7
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-621-4316
  • Fax:
Mailing address:
  • Phone: 206-621-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD00022196
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: