Provider Demographics
NPI:1609166735
Name:BAGHERPOUR, ARYA
Entity Type:Individual
Prefix:
First Name:ARYA
Middle Name:
Last Name:BAGHERPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555
Mailing Address - Country:US
Mailing Address - Phone:409-772-4870
Mailing Address - Fax:
Practice Address - Street 1:5001 EL PASO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2827
Practice Address - Country:US
Practice Address - Phone:915-521-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ04042085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology