Provider Demographics
NPI:1265442040
Name:BAIYERI, MARY O (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:O
Last Name:BAIYERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 W NORTHWEST HWY
Mailing Address - Street 2:STE 280
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8113
Mailing Address - Country:US
Mailing Address - Phone:817-416-8887
Mailing Address - Fax:817-416-8878
Practice Address - Street 1:1400 W NORTHWEST HWY
Practice Address - Street 2:STE 280
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8113
Practice Address - Country:US
Practice Address - Phone:817-416-8887
Practice Address - Fax:817-416-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2120174400000X, 2084N0402X
WI10552084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155673004Medicaid
TX174888101Medicaid
TX174888101Medicaid
TXBB7324089OtherDEA NUMBER