Provider Demographics
NPI:1376654988
Name:YIANTSOU, CHRIS G (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:G
Last Name:YIANTSOU
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 1:2600 TIBBETS DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-283-5353
Mailing Address - Fax:817-283-5355
Practice Address - Street 1:2600 TIBBETS DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-283-5353
Practice Address - Fax:817-283-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-4781207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034712201Medicaid
TX034712201Medicaid
TX00LJ24Medicare PIN