MEDICARE: APRAM BASRA D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	5101017929	MI
2	208600000X	Surgery Physician	5315037173	MI
3	208600000X	Surgery Physician	5101017929	MI
4	207P00000X	Emergency Medicine Physician	FB4598415	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P22027	OTHER	TX	EMPLOYEE ID

General Provider Information

NPI Number	:	1376787606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRAM BASRA D.O

Provider Business Mailing Address
First Line	:	900 MATISSE DR APT 4001
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2483
Country	:	US
Telephone Number	:	972-822-5885
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 MATISSE DR APT 4001
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2483
Country	:	US
Telephone Number	:	972-822-5885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	03/20/2017

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Directions to “ APRAM BASRA D.O” Practice Location

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