Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 6119 | OR |
N | 204E00000X | Oral & Maxillofacial Surgeon | 17195 | SC |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD15327 | OR |
NPI | 1104991363 |
---|---|
Provider Name | Dr. James Ferris Mose Yanney |
First Address | West Linn, OR 97068-4661 |
Second Address | West Linn, OR 97068-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 23/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194626700 | US DEPT OF LABOR (01) | |
E36774 | (02) |