Provider Demographics
NPI:1811995723
Name:BESTAWROUS, REDA SABER (MD)
Entity type:Individual
Prefix:DR
First Name:REDA
Middle Name:SABER
Last Name:BESTAWROUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6651 WATAUGA RD
Mailing Address - Street 2:STE 104
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3360
Mailing Address - Country:US
Mailing Address - Phone:817-498-6944
Mailing Address - Fax:817-581-3920
Practice Address - Street 1:6651 WATAUGA RD
Practice Address - Street 2:STE 104
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3360
Practice Address - Country:US
Practice Address - Phone:817-498-6944
Practice Address - Fax:817-581-3920
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60895Medicare UPIN
00051DMedicare ID - Type Unspecified