Provider Demographics
NPI:1265636849
Name:REZAZADEH, BAHAREH (MD)
Entity Type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:REZAZADEH
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 1:4461 COIT RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:214-297-0099
Mailing Address - Fax:214-297-0096
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 402
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:214-297-0099
Practice Address - Fax:214-297-0096
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4036207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology