Provider Demographics
NPI:1871890616
Name:JASTI, YASHWANTH (MD)
Entity type:Individual
Prefix:
First Name:YASHWANTH
Middle Name:
Last Name:JASTI
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 1:2727 BOLTON BOONE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:972-283-2370
Mailing Address - Fax:972-296-0311
Practice Address - Street 1:2727 BOLTON BOONE DR STE 109
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-283-2370
Practice Address - Fax:972-296-0311
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098400207R00000X
TXQ2143207R00000X, 207RI0200X
IN01076185A207RI0200X
LA207404207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060431Medicaid
OHH070410OtherMEDICARE PTAN
OH0060431Medicaid