Provider Demographics
NPI:1346207461
Name:ZAKHOUR, BASSAM J (MD PA)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:J
Last Name:ZAKHOUR
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N GALLOWAY AVE
Mailing Address - Street 2:210
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2476
Mailing Address - Country:US
Mailing Address - Phone:972-613-5860
Mailing Address - Fax:972-613-5893
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2476
Practice Address - Country:US
Practice Address - Phone:972-613-5860
Practice Address - Fax:972-613-5893
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8771208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122672201Medicaid
TXB62CMedicare ID - Type Unspecified
TX122672201Medicaid