Provider Demographics
NPI:1093135097
Name:BASSAM J ZAKHOUR MD PA
Entity Type:Organization
Organization Name:BASSAM J ZAKHOUR MD PA
Other - Org Name:BASSAM J ZAKHOUR MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAKHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-613-5860
Mailing Address - Street 1:929 N GALLOWAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2491
Mailing Address - Country:US
Mailing Address - Phone:972-613-5860
Mailing Address - Fax:972-613-5893
Practice Address - Street 1:929 N GALLOWAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2491
Practice Address - Country:US
Practice Address - Phone:972-613-5860
Practice Address - Fax:972-613-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty