Provider Demographics
NPI:1881666477
Name:YIMER, HABTE ARAGAW IV (MD)
Entity Type:Individual
Prefix:DR
First Name:HABTE
Middle Name:ARAGAW
Last Name:YIMER
Suffix:IV
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:501 SAUNDERS AVE STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7524
Practice Address - Country:US
Practice Address - Phone:903-579-9800
Practice Address - Fax:903-592-5988
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48089207RH0000X
TXN1232207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN754635100Medicaid
TXP00827027OtherRAILROAD MEDICARE
TX199340402Medicaid
MNP00293609Medicare ID - Type UnspecifiedRAILROAD
TXTXB100053Medicare PIN
I37614Medicare UPIN
MN830000434Medicare ID - Type Unspecified