Provider Demographics
NPI:1528054749
Name:FARRA, YASSER (DO)
Entity type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:FARRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 E COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3156
Mailing Address - Country:US
Mailing Address - Phone:830-620-1272
Mailing Address - Fax:830-620-1274
Practice Address - Street 1:1626 E COMMON ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3156
Practice Address - Country:US
Practice Address - Phone:830-620-1272
Practice Address - Fax:830-620-1274
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0989207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36390Medicare UPIN
TX8D7816Medicare PIN