Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.022414 | OH |
N | 111NI0900X | Internist | 57.022414 | OH |
Y | 207RH0003X | Hematology & Oncology | S1855 | TX |
NPI | 1003256553 |
---|---|
Provider Name | Yazan Madanat |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75235-7320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 10/06/2019 |