Provider Demographics
NPI:1255389037
Name:YAFAR ENSLING, MYRIAM CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:CRISTINA
Last Name:YAFAR ENSLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W BROADWAY
Mailing Address - Street 2:BUILDING 2 STE. A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3842
Mailing Address - Country:US
Mailing Address - Phone:573-442-2083
Mailing Address - Fax:
Practice Address - Street 1:201 W BROADWAY
Practice Address - Street 2:BUILDING 2 STE. A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3842
Practice Address - Country:US
Practice Address - Phone:573-442-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO568033OtherHEALTHLINK
MO180396OtherBLUE SHIELD/BLUE CHOICE
MOP00063573OtherRR MEDICARE
MO0404635OtherUNITED HEALTHCARE
MO180396OtherBLUE SHIELD/BLUE CHOICE
MOP00063573OtherRR MEDICARE
MO152360167Medicare PIN