Healthcare Provider Details

I. General information

NPI: 1326314584
Provider Name (Legal Business Name): RAPHAEL YE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 W AIRPORT FWY STE 215
IRVING TX
75062-5959
US

IV. Provider business mailing address

7103 DAUGHERTY ST
AUSTIN TX
78757-2117
US

V. Phone/Fax

Practice location:
  • Phone: 469-444-7246
  • Fax:
Mailing address:
  • Phone: 646-753-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR3458
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberR3458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: