Provider Demographics
NPI:1376838771
Name:BAYSSA, EYERUSALEM ENGIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:EYERUSALEM
Middle Name:ENGIDA
Last Name:BAYSSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 660132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0132
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-366-6159
Practice Address - Street 1:2005 W PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2034
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6984
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81568207RN0300X
390200000X
TXR2053207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR2053OtherTEXAS MEDICAL BOARD