Individual
DR. YASIR YAQUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13988 DIPLOMAT DR STE 100, FARMERS BRANCH, TX 75234-8831
(972) 865-4454
(214) 888-4450
Mailing address
PO BOX 2668, DESOTO, TX 75123-2668
(972) 865-4454
(214) 888-4450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
30755
OK
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
30755
OK
207RC0000X
Cardiovascular Disease Physician
30755
OK
207RI0011X
Interventional Cardiology Physician
Primary
30755
OK
207RI0011X
Interventional Cardiology Physician
N5496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200542670A
—
OK
01
—
P01383275
RR MEDICARE
OK
Enumeration date
08/14/2007
Last updated
10/22/2020
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