Healthcare Provider Details

I. General information

NPI: 1508190711
Provider Name (Legal Business Name): BARI M PHAM AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARI M HANISH

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MID CITIES BLVD STE 100 AND 130
HURST TX
76054-2792
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 817-581-2794
  • Fax: 817-656-3659
Mailing address:
  • Phone: 682-885-4432
  • Fax: 682-885-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: