Provider Demographics
NPI:1376787606
Name:BASRA, APRAM (DO)
Entity Type:Individual
Prefix:
First Name:APRAM
Middle Name:
Last Name:BASRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MATISSE DR APT 4001
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2483
Mailing Address - Country:US
Mailing Address - Phone:972-822-5885
Mailing Address - Fax:
Practice Address - Street 1:900 MATISSE DR APT 4001
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2483
Practice Address - Country:US
Practice Address - Phone:972-822-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017929207P00000X, 208600000X
MI5315037173208600000X
TXFB4598415207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP22027OtherEMPLOYEE ID