MEDICARE: DR. JAMES FERRIS MOSE YANNEY DDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6119	OR
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	17195	SC
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	MD15327	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	194626700	OTHER		US DEPT OF LABOR

General Provider Information

NPI Number	:	1104991363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES FERRIS MOSE YANNEY DDS MD

Provider Business Mailing Address
First Line	:	1672 WILLAMETTE FALLS DR
Second Line	:	SUITE D
City	:	WEST LINN
State	:	OR
Zip	:	97068-4661
Country	:	US
Telephone Number	:	503-722-4377
Fax Number	:	503-722-4413

Provider Business Practice Location Address
First Line	:	1672 WILLAMETTE FALLS DR
Second Line	:	SUITE D
City	:	WEST LINN
State	:	OR
Zip	:	97068-4661
Country	:	US
Telephone Number	:	503-722-4377
Fax Number	:	503-722-4413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	04/23/2015

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