Provider Demographics
NPI:1134189566
Name:DANESHFAR, BAHMAN ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:ABRAHAM
Last Name:DANESHFAR
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 1:302 ARABELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6054
Mailing Address - Country:US
Mailing Address - Phone:337-593-7285
Mailing Address - Fax:
Practice Address - Street 1:302 ARABELLA BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6054
Practice Address - Country:US
Practice Address - Phone:337-593-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO09493R2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA09493ROtherLICENSE
LA1957402Medicaid
920000960OtherRAILROAD MEDICARE
721255624OtherTAX ID
LA09493ROtherLICENSE
LAF44932Medicare UPIN