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General NPI Number Information
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NPI Number | 1609106020
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Entity Type | Individual
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Provider Name | IBRAHIM YAZJI MD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 22999 HIGHWAY 59 N STE 200
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City | KINGWOOD
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State | TX
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Zip | 77339
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Country | US
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Telephone | 281-312-6457
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Fax | 281-312-5128
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Provider Business Mailing Address
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Address Line | 22999 HIGHWAY 59 N STE 200
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City | KINGWOOD
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State | TX
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Zip | 77339-4439
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Country | US
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Telephone | 281-312-6457
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Fax | 813-125-1282
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME133566
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | R9705
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License Number State | TX
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