Individual
DR. ESMAEL FANTAW YIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-7264
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
T3019
TX
208M00000X
Hospitalist Physician
T3019
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1T2021
MEDICARE
TX
05
—
429496901
—
TX
01
—
8BQ442
BCBS
TX
Enumeration date
04/05/2018
Last updated
08/18/2023
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