Provider Demographics
NPI:1548310691
Name:ANBAR, BAHAR (PA)
Entity type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:ANBAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BAHAR
Other - Middle Name:
Other - Last Name:ANBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-991-4026
Practice Address - Street 1:1341 W MOCKINGBIRD LN
Practice Address - Street 2:MOCKINGBIRD TOWERS, STE 710E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6913
Practice Address - Country:US
Practice Address - Phone:214-217-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02045363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS58820Medicare UPIN