Healthcare Provider Details

I. General information

NPI: 1912347618
Provider Name (Legal Business Name): YASIR USMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S MADISON ST
ENID OK
73701-7273
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 580-213-9741
  • Fax:
Mailing address:
  • Phone: 405-552-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30053
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: