Provider Demographics
NPI:1306855283
Name:YOCKEY, CHARLES C (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:YOCKEY
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 1:1130 W 4TH ST
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1328
Mailing Address - Country:US
Mailing Address - Phone:785-505-3205
Mailing Address - Fax:785-505-5261
Practice Address - Street 1:1130 W 4TH ST
Practice Address - Street 2:SUITE 2001
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1328
Practice Address - Country:US
Practice Address - Phone:785-505-3205
Practice Address - Fax:785-505-5261
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS417097207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100310950BMedicaid
KS100310950BMedicaid
KS105264Medicare ID - Type Unspecified