Provider Demographics
NPI:1518315746
Name:DAABOUL, YAZAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAZAN
Middle Name:
Last Name:DAABOUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YAZ
Other - Middle Name:
Other - Last Name:DAABOUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1210 KY HIGHWAY 36 E STE G3
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7492
Mailing Address - Country:US
Mailing Address - Phone:859-235-3562
Mailing Address - Fax:859-234-3967
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-235-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP554207R00000X, 207RC0000X
MA267596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine