Healthcare Provider Details

I. General information

NPI: 1932281342
Provider Name (Legal Business Name): KHALID BAZIR M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NW NEWTON DR STE C
BURLESON TX
76028-4793
US

IV. Provider business mailing address

PO BOX 1899
BURLESON TX
76097-1899
US

V. Phone/Fax

Practice location:
  • Phone: 817-426-3323
  • Fax: 817-426-3353
Mailing address:
  • Phone: 817-426-3323
  • Fax: 817-426-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL7942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: