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General NPI Number Information
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NPI Number | 1942688239
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Entity Type | Individual
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Provider Name | RAED AL YACOUB M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3003
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Country | US
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Telephone | 352-294-8278
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Fax | 352-265-0379
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Provider Business Mailing Address
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Address Line | 462 GRIDER ST. ECMC
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City | BUFFALO
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State | NY
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Zip | 14213
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Country | US
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Telephone | 716-898-4226
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME139692
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | ME139692
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License Number State | FL
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