Provider Demographics
NPI:1366465122
Name:MORA, YEZID FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:YEZID
Middle Name:FERNANDO
Last Name:MORA
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 1:13737 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-7516
Mailing Address - Country:US
Mailing Address - Phone:979-793-3940
Mailing Address - Fax:979-793-3945
Practice Address - Street 1:13737 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-7516
Practice Address - Country:US
Practice Address - Phone:979-793-3940
Practice Address - Fax:979-793-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1944207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI07493Medicare UPIN