Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 01053985A | IN |
Y | 207RG0300X | Geriatric Medicine | M4524 | TX |
NPI | 1053369280 |
---|---|
Provider Name | Youcef Sennour |
First Address | Dallas, TX 75246-1607 |
Second Address | Dallas, TX 75246-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 18/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200425510 | (05) | IN |
212486901 | (05) | TX |
H81676 | (02) | IN |