Healthcare Provider Details

I. General information

NPI: 1467438911
Provider Name (Legal Business Name): NABIL AMIN YASSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/29/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

IV. Provider business mailing address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-3550
  • Fax:
Mailing address:
  • Phone: 189-353-5509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA51646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA51646
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA51646
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA51646
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA51646
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA51646
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberA51646
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA51646
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License NumberA51646
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA51646
License Number StateCA
# 11
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16910
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: