Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2002-0386 | NM |
N | 111NI0900X | Internist | 2002-0386 | NM |
N | 207R00000X | Internist | C53263 | CA |
N | 111NI0900X | Internist | C53263 | CA |
NPI | 1003802463 |
---|---|
Provider Name | Dr. Hany Nagy Yassa |
First Address | Roswell, NM 88202-1029 |
Second Address | Roswell, NM 88201-5209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 27/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
97306754 | (05) | NM |
H76903 | (02) | NM |
NM007E65 | BCBS (01) | NM |