Provider Demographics
NPI:1255307807
Name:YEARIAN, PHILIP R (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:YEARIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-7257
Practice Address - Fax:253-582-1617
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA346704OtherWA STATE LNI
WA1005973Medicaid
U57227Medicare UPIN
WAG8947639Medicare PIN
WA0256779OtherSTATE L&I
WA1121169Medicaid