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General NPI Number Information
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NPI Number | 1306104336
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Entity Type | Organization
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Legal Business Name | THE VASCULAR GROUP OF BRADENTON, P.L.
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 4502 CORTEZ RD W 2ND FLOOR
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City | BRADENTON
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State | FL
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Zip | 34210-3143
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Country | US
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Telephone | 813-286-0033
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Fax | 813-489-2537
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Provider Business Mailing Address
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Address Line | PO BOX 25317
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City | TAMPA
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State | FL
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Zip | 33622-5317
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Country | US
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Telephone | 813-286-0033
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Fax | 813-489-2537
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Authorized Official
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Title or Position | OWNER
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Name | DR. WOODROW W YEANEY III
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Credential | M.D.
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Telephone | 813-286-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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