Provider Demographics
NPI:1053369280
Name:SENNOUR, YOUCEF (MD)
Entity type:Individual
Prefix:
First Name:YOUCEF
Middle Name:
Last Name:SENNOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 WORTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1607
Mailing Address - Country:US
Mailing Address - Phone:214-820-6060
Mailing Address - Fax:214-820-6361
Practice Address - Street 1:4004 WORTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1607
Practice Address - Country:US
Practice Address - Phone:214-820-6060
Practice Address - Fax:214-820-6361
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053985A207RG0300X
TXM4524207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212486901Medicaid
IN200425510Medicaid
IN200425510Medicaid
INH81676Medicare UPIN
IN715530T5Medicare PIN