Provider Demographics
NPI:1710908744
Name:BEHNAM, SOROUSH (MD)
Entity Type:Individual
Prefix:
First Name:SOROUSH
Middle Name:
Last Name:BEHNAM
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 1:4300 CITY POINT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8380
Mailing Address - Country:US
Mailing Address - Phone:817-255-1940
Mailing Address - Fax:469-713-8379
Practice Address - Street 1:9250 AMBERTON PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3224
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7663207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168068806Medicaid
TX168068803Medicaid
TX168068809Medicaid
TX179478601Medicaid
TX168068801Medicaid
TX168068802Medicaid
TX168068804Medicaid
TX168068807Medicaid
TX168068808Medicaid
TX8J9027Medicare PIN
TX168068803Medicaid
TX168068804Medicaid
TXTXB122228Medicare PIN
TXTXB126774Medicare PIN
TX8C6609Medicare PIN
TX8J9890Medicare PIN
TX8G5405Medicare PIN
TX168068801Medicaid
TX168068807Medicaid
TXTXB111729Medicare PIN