Provider Demographics
NPI:1588248769
Name:IBRAHIM YAZJI MD PLLC
Entity type:Organization
Organization Name:IBRAHIM YAZJI MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAZJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-910-2307
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-0150
Mailing Address - Country:US
Mailing Address - Phone:281-899-0229
Mailing Address - Fax:281-803-8381
Practice Address - Street 1:24044 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1500
Practice Address - Country:US
Practice Address - Phone:281-899-0229
Practice Address - Fax:281-803-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty