Provider Demographics
NPI:1902987894
Name:YARDLEY, TREVOR WAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:WAYNE
Last Name:YARDLEY
Suffix:
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 1:6780 MANASOTA KEY RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-9263
Mailing Address - Country:US
Mailing Address - Phone:814-243-6870
Mailing Address - Fax:240-363-0256
Practice Address - Street 1:6780 MANASOTA KEY RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-9263
Practice Address - Country:US
Practice Address - Phone:814-243-6870
Practice Address - Fax:240-363-0256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036575E207X00000X
FLME161501207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00010633550002Medicaid
B41756Medicare UPIN