Provider Demographics
NPI:1972547784
Name:YEARLEY, ANITA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:YEARLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-1711
Practice Address - Fax:253-581-6588
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036471207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2264YEOtherBSWA
WA8246928Medicaid
WA0170819OtherLIWA
WA0170829OtherLIWA
WA2164YEOtherBSWA
WA8373YEOtherBSWA
WAG8852543Medicare PIN
WA2164YEOtherBSWA
WA2264YEOtherBSWA
WAGAB27507Medicare PIN
WA8373YEOtherBSWA