Provider Demographics
NPI:1033274949
Name:YULE, GEOFFREY J (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:J
Last Name:YULE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 TALBOT RD S
Mailing Address - Street 2:STE 105
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-255-5494
Mailing Address - Fax:425-255-5033
Practice Address - Street 1:4300 TALBOT RD S
Practice Address - Street 2:STE 105
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-255-5494
Practice Address - Fax:425-255-5033
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034898208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0119505OtherL & I NUMBER
WA1103340Medicaid
WA1103340Medicaid
WABY3561443OtherDEA NUMBER
WA0119505OtherL & I NUMBER
WA911895206OtherTAX ID NUMBER
WA261605809OtherEIN EFFECTIVE 1/1/08