Provider Demographics
NPI:1134227564
Name:SALIM F DABAGHI, MD, PA
Entity type:Organization
Organization Name:SALIM F DABAGHI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:FARID
Authorized Official - Last Name:DABAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-849-1414
Mailing Address - Street 1:4005 TECHNOLOGY RD STE 1510
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2557
Mailing Address - Country:US
Mailing Address - Phone:979-849-1414
Mailing Address - Fax:877-809-2721
Practice Address - Street 1:146 E HOSPITAL DR
Practice Address - Street 2:STE. 201
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4169
Practice Address - Country:US
Practice Address - Phone:979-849-1414
Practice Address - Fax:979-849-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDA1376OtherMEDICARE RR GROUP #
TX160571901Medicaid
TX00145VOtherBCBS GROUP #
TX00145VOtherBCBS GROUP #