Provider Demographics
NPI:1366656993
Name:YAQUB, SOBIA (MD)
Entity Type:Individual
Prefix:
First Name:SOBIA
Middle Name:
Last Name:YAQUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PRESTON RD STE 2066
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5200
Mailing Address - Country:US
Mailing Address - Phone:469-833-2623
Mailing Address - Fax:877-513-4005
Practice Address - Street 1:1921 PRESTON RD STE 2066
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5200
Practice Address - Country:US
Practice Address - Phone:469-833-2623
Practice Address - Fax:877-513-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099360207R00000X
TXS1310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074052Medicaid
P01112538OtherRAILROAD MEDICARE
202045693028OtherCARESOURCE
OHH133360Medicare PIN