Provider Demographics
NPI:1710177555
Name:BIDGOLI, ARASH (DO)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:BIDGOLI
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 1:3920 WHEATLAND ROAD, SUITE 134
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3404
Mailing Address - Country:US
Mailing Address - Phone:214-941-3192
Mailing Address - Fax:214-941-3762
Practice Address - Street 1:3920 WHEATLAND ROAD, SUITE 134
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3404
Practice Address - Country:US
Practice Address - Phone:214-941-3192
Practice Address - Fax:214-941-3762
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6180208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282719801Medicaid
TX282719803Medicaid
TXTXB123198Medicare PIN
TX282719801Medicaid
TXTXB123196Medicare PIN