Provider Demographics
NPI:1932281342
Name:BAZIR, KHALID (MD,)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:BAZIR
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:PO BOX 1899
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1899
Mailing Address - Country:US
Mailing Address - Phone:817-426-3323
Mailing Address - Fax:817-426-3353
Practice Address - Street 1:115 NW NEWTON DR STE C
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4793
Practice Address - Country:US
Practice Address - Phone:817-426-3323
Practice Address - Fax:817-426-3353
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0060PTOtherBCBS
TX191414501Medicaid
P00476696OtherMEDICARE RAILROAD
TX8CR434OtherBCBS
TX191414501Medicaid
TXI31689Medicare UPIN
TX8CR434OtherBCBS
TX8D6101Medicare ID - Type Unspecified
TX613105Medicare PIN