MEDICARE: HOSSEIN BAGSHAHI M.D.

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	208600000X	Surgery Physician	233983	MA
2	208600000X	Surgery Physician	P1846	TX

General Provider Information

NPI Number	:	1528117348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOSSEIN BAGSHAHI M.D.

Provider Business Mailing Address
First Line	:	800 5TH AVE STE 404
Second Line	:	BEN HOGAN BLDG.
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7305
Country	:	US
Telephone Number	:	817-250-6210
Fax Number	:	817-250-6211

Provider Business Practice Location Address
First Line	:	800 5TH AVE STE 404
Second Line	:	BEN HOGAN BLDG.
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7305
Country	:	US
Telephone Number	:	817-250-6210
Fax Number	:	817-250-6211

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/27/2013

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