MEDICARE: DR. EYERUSALEM ENGIDA BAYSSA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	R2053	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R2053	OTHER	TX	TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1376838771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EYERUSALEM ENGIDA BAYSSA M.D

Provider Business Mailing Address
First Line	:	1505 LBJ FWY STE 700
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-6065
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	214-579-6941

Provider Business Practice Location Address
First Line	:	3800 GAYLORD PKWY STE 910
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9419
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	972-685-4881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	05/09/2024

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