Provider Demographics
NPI:1568882405
Name:BSISO, ADAM (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BSISO
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 1:1301 W HENDERSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5117
Mailing Address - Country:US
Mailing Address - Phone:817-558-3937
Mailing Address - Fax:817-422-0862
Practice Address - Street 1:1301 W HENDERSON ST STE A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5117
Practice Address - Country:US
Practice Address - Phone:817-558-3937
Practice Address - Fax:817-422-0862
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10049289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine