Provider Demographics
NPI:1205869773
Name:BAHRAMI, CARLOS S (DO)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:S
Last Name:BAHRAMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-339-8889
Practice Address - Street 1:508 S ADAMS ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2151
Practice Address - Country:US
Practice Address - Phone:817-339-8855
Practice Address - Fax:817-339-8889
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3878207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184625503Medicaid
TXP00791930OtherRAILROAD MEDICARE