Provider Demographics
NPI:1295919603
Name:JOSEPH E. YANKEE DO PC
Entity type:Organization
Organization Name:JOSEPH E. YANKEE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:YANKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-652-1456
Mailing Address - Street 1:6564 SE LAKE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2238
Mailing Address - Country:US
Mailing Address - Phone:503-652-1456
Mailing Address - Fax:503-652-1451
Practice Address - Street 1:6564 SE LAKE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2238
Practice Address - Country:US
Practice Address - Phone:503-652-1456
Practice Address - Fax:503-652-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19458173000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150872Medicaid
132814Medicare PIN
OR150872Medicaid