Provider Demographics
NPI:1912952227
Name:BIDGOLI, ASHKAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:BIDGOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:R
Other - Last Name:BIDGOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1441 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1201
Mailing Address - Country:US
Mailing Address - Phone:214-942-5733
Mailing Address - Fax:214-942-6115
Practice Address - Street 1:2700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5899
Practice Address - Country:US
Practice Address - Phone:682-622-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3162207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R3173OtherBCBS
TX8J1866OtherBCBS WITH AEMA
TX176933301Medicaid
TXP00038768OtherRR MEDICARE
TXP01161489OtherRAILROAD MCARE
TX176933303Medicaid
TX176933305Medicaid
TX176933308Medicaid
TX8BT313OtherBCBS THRU SAEMA
TX8W7098OtherBCBS
TX8G8522OtherMEDICARE
TX8L2200Medicare PIN
TX265903YMLBMedicare PIN
TXP00038768OtherRR MEDICARE
TX176933303Medicaid
TX176933308Medicaid