Provider Demographics
NPI:1760669972
Name:GEOFFREY J YULE, MD PS
Entity Type:Organization
Organization Name:GEOFFREY J YULE, MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-255-5494
Mailing Address - Street 1:4300 TALBOT RD S STE 105
Mailing Address - Street 2:
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 STE 105
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034898208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0119505OtherL & I NUMBER
WA1103340Medicaid
WA1103340Medicaid
WA0119505OtherL & I NUMBER