Provider Demographics
NPI:1588245468
Name:EKORTARH, YANICK A (MD)
Entity type:Individual
Prefix:
First Name:YANICK
Middle Name:A
Last Name:EKORTARH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YANICK
Other - Middle Name:AYUK
Other - Last Name:EKOR TARH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:956-729-9738
Mailing Address - Fax:956-729-0291
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY STE 101B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-729-9738
Practice Address - Fax:956-729-0291
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35187207Q00000X
TXT4354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine