Provider Demographics
NPI:1932391844
Name:YAQUB, YASIR (MD)
Entity Type:Individual
Prefix:DR
First Name:YASIR
Middle Name:
Last Name:YAQUB
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:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75123-2668
Mailing Address - Country:US
Mailing Address - Phone:972-865-4454
Mailing Address - Fax:214-888-4450
Practice Address - Street 1:13988 DIPLOMAT DR STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-8831
Practice Address - Country:US
Practice Address - Phone:972-865-4454
Practice Address - Fax:214-888-4450
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30755207R00000X, 207RA0000X, 207RC0000X, 207RI0011X
TXN5496207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01383275OtherRR MEDICARE
OK200542670AMedicaid
OK200542670AMedicaid