Provider Demographics
NPI:1477127744
Name:GIBRAN, YAMAN (MD)
Entity type:Individual
Prefix:
First Name:YAMAN
Middle Name:
Last Name:GIBRAN
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 1:2102 TREASURE HILLS BLVD, VBMC DEPT. OF MEDICINE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-296-1491
Mailing Address - Fax:956-389-4603
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6402
Practice Address - Country:US
Practice Address - Phone:570-278-3801
Practice Address - Fax:570-278-2177
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-10-16
Deactivation Date:2022-11-07
Deactivation Code:
Reactivation Date:2023-01-30
Provider Licenses
StateLicense IDTaxonomies
TXBP10074648390200000X
PAMD482747207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program