Healthcare Provider Details

I. General information

NPI: 1104146216
Provider Name (Legal Business Name): YAGNESH KANTI DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

901 TURTLE CREEK DR
TYLER TX
75701-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3651
  • Fax:
Mailing address:
  • Phone: 903-596-3651
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP8884
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20988
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number204665
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: