Healthcare Provider Details

I. General information

NPI: 1962509901
Provider Name (Legal Business Name): NEYSAN BAYAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/24/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 E GRIFFIN PKWY
MISSION TX
78572-3222
US

IV. Provider business mailing address

807 PARKVIEW CIR
HARLINGEN TX
78550-5825
US

V. Phone/Fax

Practice location:
  • Phone: 956-600-7747
  • Fax: 866-221-2183
Mailing address:
  • Phone: 956-600-7747
  • Fax: 866-221-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number017427
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberP4926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: