Provider Demographics
NPI:1083699276
Name:YONEHIRO, LAYNE R (MD)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:R
Last Name:YONEHIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30090
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1090
Mailing Address - Country:US
Mailing Address - Phone:850-429-0102
Mailing Address - Fax:850-429-0830
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 533
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-429-0102
Practice Address - Fax:850-429-0830
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35697208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113916Medicaid
FL17460OtherBLUE CROSS BLUE SHIELD
AL009912355Medicaid
FL038629400Medicaid
FLZ444OtherHEALTH FIRST NETWORK
AL009912365Medicaid
AL515-13360OtherBLUE CROSS BLUE SHIELD
FL770003263OtherMEDICARE RAILROAD
AL101160Medicaid
AL592-08805OtherBLUE CROSS BLUE SHIELD
AL511-13450OtherBLUE CROSS BLUE SHIELD
AL59070273OtherBLUE CROSS BLUE SHIELD
AL009912375Medicaid
AL591-97082OtherBLUE CROSS BLUE SHIELD
FL038629400Medicaid
AL051513360Medicare PIN
AL515-13360OtherBLUE CROSS BLUE SHIELD