MEDICARE: DR. SHARON GRIMES BAKOS 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	174400000X	Specialist	G3127	TX
2	207V00000X	Obstetrics & Gynecology Physician	G3127	TX

General Provider Information

NPI Number	:	1639175847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON GRIMES BAKOS M.D.

Provider Business Mailing Address
First Line	:	519 FARINE DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-3632
Country	:	US
Telephone Number	:	972-255-8549
Fax Number	:	972-255-8549

Provider Business Practice Location Address
First Line	:	3500 GASTON AVE
Second Line	:	LABOR AND DELIVERY
City	:	DALLAS
State	:	TX
Zip	:	75246-2017
Country	:	US
Telephone Number	:	866-240-8099
Fax Number	:	972-255-8549

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/19/2011

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