1912952227 NPI number — DR. ASHKAN BIDGOLI DO

Table of content: DR. ASHKAN BIDGOLI DO (NPI 1912952227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912952227 NPI number — DR. ASHKAN BIDGOLI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIDGOLI
Provider First Name:
ASHKAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIDGOLI
Provider Other First Name:
MOHAMAD
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912952227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 N BECKLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75203-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-942-5733
Provider Business Mailing Address Fax Number:
214-942-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-5899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-622-7139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  M3162 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8R3173 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J1866 . This is a "BCBS WITH AEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 176933301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00038768 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01161489 . This is a "RAILROAD MCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 176933303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176933305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176933308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BT313 . This is a "BCBS THRU SAEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8W7098 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8G8522 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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