Healthcare Provider Details

I. General information

NPI: 1447552039
Provider Name (Legal Business Name): BAHRAUM DANIEL DANESHFAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 GARFIELD AVE
HARLAN IA
51537-2057
US

IV. Provider business mailing address

24 CARE CIR
AMARILLO TX
79124-2118
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-5161
  • Fax:
Mailing address:
  • Phone: 806-353-6100
  • Fax: 806-353-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116019163
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP7630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: