Provider Demographics
NPI:1225081789
Name:BACHIR, GHASSAN SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:SIMON
Last Name:BACHIR
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 1:9526 NORTH WINERY AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4600
Mailing Address - Country:US
Mailing Address - Phone:559-250-9588
Mailing Address - Fax:559-322-5182
Practice Address - Street 1:720 E. ALMOND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5691
Practice Address - Country:US
Practice Address - Phone:559-661-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42006208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU052AMedicare PIN
CAA29490Medicare UPIN
CABU052BMedicare PIN