Healthcare Provider Details

I. General information

NPI: 1518352954
Provider Name (Legal Business Name): PARHAM BAHADOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-5977
  • Fax:
Mailing address:
  • Phone: 318-769-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number307372
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS1558
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: