Provider Demographics
NPI:1326045923
Name:PAZANDAK, BRADFORD B (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:B
Last Name:PAZANDAK
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 1:4505 HARRYS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5405
Mailing Address - Country:US
Mailing Address - Phone:214-361-1443
Mailing Address - Fax:214-351-2991
Practice Address - Street 1:4505 HARRYS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5405
Practice Address - Country:US
Practice Address - Phone:214-361-1443
Practice Address - Fax:214-351-2993
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25406Medicare UPIN