Provider Demographics
NPI:1154654861
Name:KHOURI, YAZAN SUHEL (MD)
Entity type:Individual
Prefix:DR
First Name:YAZAN
Middle Name:SUHEL
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8506
Mailing Address - Country:US
Mailing Address - Phone:903-731-0509
Mailing Address - Fax:903-731-0509
Practice Address - Street 1:126 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8506
Practice Address - Country:US
Practice Address - Phone:903-731-0509
Practice Address - Fax:903-731-0509
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094715207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine