Provider Demographics
NPI:1811184369
Name:YANITY, JOSEPH BLAIR IV (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BLAIR
Last Name:YANITY
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 4TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2351
Mailing Address - Country:US
Mailing Address - Phone:415-514-3617
Mailing Address - Fax:415-353-1202
Practice Address - Street 1:1975 4TH ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:415-514-3617
Practice Address - Fax:415-353-1202
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005287363A00000X
363AS0400X
CA54584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4719YAOtherBLUE SHIELD #
WA8501728Medicaid
WA4719YAOtherBLUE SHIELD #