MEDICARE: YAW SAFO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	G4205	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083642664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAW SAFO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 380910
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75138-0910
Country	:	US
Telephone Number	:	972-296-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7989 W VIRGINIA DR
Second Line	:	SUITE 102
City	:	DALLAS
State	:	TX
Zip	:	75237-3765
Country	:	US
Telephone Number	:	972-296-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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