Provider Demographics
NPI:1154623296
Name:KHALID BAZIR MD PA
Entity type:Organization
Organization Name:KHALID BAZIR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-426-3323
Mailing Address - Street 1:PO BOX 1899
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1899
Mailing Address - Country:US
Mailing Address - Phone:817-426-3323
Mailing Address - Fax:817-426-3353
Practice Address - Street 1:115 NW NEWTON DR STE C
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4793
Practice Address - Country:US
Practice Address - Phone:817-426-3323
Practice Address - Fax:817-426-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0091WCOtherBCBS
TXTXB123887Medicare PIN
TXTXB123885Medicare PIN