Individual
ILYAS YAMBAYEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7000
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
286413
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110127115A
—
MA
Enumeration date
03/21/2017
Last updated
09/19/2024
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