Provider Demographics
NPI:1447413190
Name:BAKSH, JAVID MU'AZ (DO)
Entity Type:Individual
Prefix:
First Name:JAVID
Middle Name:MU'AZ
Last Name:BAKSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WALDEN RIDGE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8592
Mailing Address - Country:US
Mailing Address - Phone:833-365-7246
Mailing Address - Fax:
Practice Address - Street 1:9 WALDEN RIDGE DR STE 10
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8592
Practice Address - Country:US
Practice Address - Phone:833-365-7246
Practice Address - Fax:828-348-4971
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-04-06
Deactivation Date:2021-05-13
Deactivation Code:
Reactivation Date:2021-05-19
Provider Licenses
StateLicense IDTaxonomies
SC51911207LP2900X
NC2012-01181208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447413190OtherBCBSNC
NC5920804Medicaid