Provider Demographics
NPI:1740217116
Name:YEANEY, WOODROW W III (MD)
Entity type:Individual
Prefix:
First Name:WOODROW
Middle Name:W
Last Name:YEANEY
Suffix:III
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 1:4502 CORTEZ RD W
Mailing Address - Street 2:STE 200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3124
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-489-2537
Practice Address - Street 1:4502 CORTEZ RD W FL 2
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3143
Practice Address - Country:US
Practice Address - Phone:941-243-3991
Practice Address - Fax:941-243-3953
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004014532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276615900Medicaid
FLAB339ZMedicare PIN