Provider Demographics
NPI:1013936715
Name:BAYAZITOGLU, MATT Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:Y
Last Name:BAYAZITOGLU
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 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:214-820-8557
Mailing Address - Fax:214-480-8356
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-820-8557
Practice Address - Fax:214-480-8356
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13887208100000X
AL27753208100000X
TXM39012081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201893902Medicaid
TX8BU824OtherBCBSTX
AL051537986Medicaid
AL515-37986OtherBC BS OF AL
TX201893901Medicaid
TX8L14035Medicare PIN
AL515-37986OtherBC BS OF AL
AL051537986Medicaid
TX8L10962Medicare PIN
TX201893902Medicaid