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General NPI Number Information
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NPI Number | 1588245468
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Entity Type | Individual
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Provider Name | YANICK A EKORTARH MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 4151 JAIME ZAPATA MEMORIAL HWY STE 101B
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City | LAREDO
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State | TX
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Zip | 78043-4741
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Country | US
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Telephone | 956-729-9738
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Fax | 956-729-0291
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 956-729-9738
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Fax | 956-729-0291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35187
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T4354
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License Number State | TX
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