Provider Demographics
NPI:1679671127
Name:DABAGHI, SALIM FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:SALIM
Middle Name:FARID
Last Name:DABAGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 TECHNOLOGY RD STE 1510
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2557
Mailing Address - Country:US
Mailing Address - Phone:979-849-1414
Mailing Address - Fax:877-809-2721
Practice Address - Street 1:4005 TECHNOLOGY RD STE 1510
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-2557
Practice Address - Country:US
Practice Address - Phone:979-849-1414
Practice Address - Fax:877-809-2721
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1222174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX688325OtherAETNA #
TX1334169OtherUNITED HEALTHCARE #
TXP00169704OtherMEDICARE RAILROAD INDIV #
TX10021226OtherAMERIGROUP #
TX160579201Medicaid
TX688325OtherAETNA
TX8A6548OtherBCBS INDIVIDUAL #
TX8A6548OtherBCBS INDIVIDUAL #