Provider Demographics
NPI:1639359466
Name:BAYTOWN OCCUPATIONAL & FAMILY MEDICINE P.A.
Entity Type:Organization
Organization Name:BAYTOWN OCCUPATIONAL & FAMILY MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR MD.
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI-ADLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-420-4000
Mailing Address - Street 1:4002 GARTH ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3114
Mailing Address - Country:US
Mailing Address - Phone:281-420-4000
Mailing Address - Fax:281-428-4940
Practice Address - Street 1:4002 GARTH ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3114
Practice Address - Country:US
Practice Address - Phone:281-420-4000
Practice Address - Fax:281-428-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7111207Q00000X, 261QP2300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210760901Medicaid
TX210760901Medicaid