Healthcare Provider Details

I. General information

NPI: 1376654988
Provider Name (Legal Business Name): CHRIS G YIANTSOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TIBBETS DR
BEDFORD TX
76022
US

IV. Provider business mailing address

2600 TIBBETS DR
BEDFORD TX
76022
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-5353
  • Fax: 817-283-5355
Mailing address:
  • Phone: 817-283-5353
  • Fax: 817-283-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberE-4781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: