Provider Demographics
NPI:1356377816
Name:ABU QWAIDER, YAZAN A (MD)
Entity type:Individual
Prefix:
First Name:YAZAN
Middle Name:A
Last Name:ABU QWAIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YAZAN
Other - Middle Name:ASAD
Other - Last Name:ABU QWAIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:17350 ST LUKES WAY STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4103
Practice Address - Country:US
Practice Address - Phone:936-266-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032798207RG0100X
IN01054577A207RG0100X
MS30770207RG0100X
TXL3549207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93834845Medicaid
COCO306435Medicare PIN
H47859Medicare UPIN
C803093Medicare PIN