Provider Demographics
NPI:1528117348
Name:BAGSHAHI, HOSSEIN (MD)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:BAGSHAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 5TH AVE STE 404
Mailing Address - Street 2:BEN HOGAN BLDG.
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7305
Mailing Address - Country:US
Mailing Address - Phone:817-250-6210
Mailing Address - Fax:817-250-6211
Practice Address - Street 1:800 5TH AVE STE 404
Practice Address - Street 2:BEN HOGAN BLDG.
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7305
Practice Address - Country:US
Practice Address - Phone:817-250-6210
Practice Address - Fax:817-250-6211
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233983208600000X
TXP1846208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306330YKPWMedicare PIN