Provider Demographics
NPI:1083642664
Name:SAFO, YAW (MD)
Entity Type:Individual
Prefix:
First Name:YAW
Middle Name:
Last Name:SAFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380910
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-0910
Mailing Address - Country:US
Mailing Address - Phone:972-296-3700
Mailing Address - Fax:
Practice Address - Street 1:7989 W VIRGINIA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3765
Practice Address - Country:US
Practice Address - Phone:972-296-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098203502Medicaid
TX86K153Medicare ID - Type Unspecified
TX098203502Medicaid