Provider Demographics
NPI:1417956111
Name:KAVOUSPOUR, DARIOUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIOUSH
Middle Name:
Last Name:KAVOUSPOUR
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 1:4355 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7468
Mailing Address - Country:US
Mailing Address - Phone:409-899-7863
Mailing Address - Fax:409-899-7862
Practice Address - Street 1:2965 HARRISON ST STE 211
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1149
Practice Address - Country:US
Practice Address - Phone:409-899-8501
Practice Address - Fax:409-899-8510
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4467208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO89011J2Medicaid
TXG08177Medicare UPIN
TX8354M2Medicare ID - Type Unspecified
TXPO89011J2Medicaid