MEDICARE: JAMES FM 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	MD15327	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104991363	OTHER		NPI

General Provider Information

NPI Number	:	1306096797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES FM 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	:	PHYSICIAN
Name	:	DR. JAMES F.M. YANNEY
Credential	:	MD
Telephone Number	:	503-722-4377

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	05/06/2015

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