Provider Demographics
NPI:1992740773
Name:YEDWAB, ALAN JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JEFFREY
Last Name:YEDWAB
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4266
Mailing Address - Country:US
Mailing Address - Phone:214-320-1661
Mailing Address - Fax:214-320-1691
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE 308
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4266
Practice Address - Country:US
Practice Address - Phone:214-320-1661
Practice Address - Fax:214-320-1691
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK5437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00797JMedicare ID - Type Unspecified
TXH05138Medicare UPIN