Provider Demographics
NPI:1518277045
Name:RAHBANI, BECHARA W (PA)
Entity Type:Individual
Prefix:
First Name:BECHARA
Middle Name:W
Last Name:RAHBANI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460TH MEDICAL GROUP
Mailing Address - Street 2:275 S. ASPEN STREET, STOP 89
Mailing Address - City:BUCKLEY SFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:720-847-7473
Mailing Address - Fax:866-230-7946
Practice Address - Street 1:460TH MEDICAL GROUP
Practice Address - Street 2:275 S. ASPEN STREET, STOP 89
Practice Address - City:BUCKLEY SFB
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:720-847-7473
Practice Address - Fax:866-230-7946
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians