Provider Demographics
NPI:1760455745
Name:SLOANE, YANCEY JR (MD)
Entity type:Individual
Prefix:
First Name:YANCEY
Middle Name:
Last Name:SLOANE
Suffix:JR
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 1:6401 KIMBALL DR
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1228
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:253-534-7099
Practice Address - Street 1:6401 KIMBALL DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1228
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:253-534-7099
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD600111510207R00000X
WAMD60011510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10033667Medicaid
WA1092722Medicaid
WAG8963545Medicare PIN