Individual
YASSER M MOKHTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804-3503
(417) 347-1111
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-1111
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
2007007783
MO
207RP1001X
Pulmonary Disease Physician
2007007783
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052900
—
MO
05
—
200113520A
—
OK
05
—
200428260A
—
KS
01
—
219343
ANTHAM
MO
01
—
P00403969
RR MEDICARE
—
Enumeration date
03/29/2007
Last updated
12/19/2016
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