Provider Demographics
NPI:1851408496
Name:VALDERRAMA-BAZAN, FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:
Last Name:VALDERRAMA-BAZAN
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 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-839-4757
Mailing Address - Fax:409-839-4294
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 320
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-839-4757
Practice Address - Fax:409-839-4294
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172224101Medicaid
TX123414807Medicaid
TX123414807Medicaid
TX172224101Medicaid