Provider Demographics
NPI:1033778980
Name:ELQUTUB, YASER HANY (DO)
Entity Type:Individual
Prefix:
First Name:YASER
Middle Name:HANY
Last Name:ELQUTUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N CENTRAL EXPY STE 365
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6532
Mailing Address - Country:US
Mailing Address - Phone:281-536-1469
Mailing Address - Fax:606-259-9165
Practice Address - Street 1:4300 N CENTRAL EXPY STE 365
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6532
Practice Address - Country:US
Practice Address - Phone:281-536-1469
Practice Address - Fax:606-259-9165
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine