Provider Demographics
NPI:1134131667
Name:YEARY, SUZANNE E (DO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:YEARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14048 JUANITA DR NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-5300
Mailing Address - Fax:425-899-5304
Practice Address - Street 1:14048 JUANITA DR NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5312
Practice Address - Country:US
Practice Address - Phone:425-899-5300
Practice Address - Fax:425-899-5304
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7537YEOtherREGENCE BLUE SHIELD
WA192463OtherLABOR AND INDUSTRIES
WAE20239Medicare UPIN
WAAB20999Medicare ID - Type Unspecified