Provider Demographics
NPI:1447552039
Name:DANESHFAR, BAHRAUM DANIEL (MD)
Entity type:Individual
Prefix:
First Name:BAHRAUM
Middle Name:DANIEL
Last Name:DANESHFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CARE CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2118
Mailing Address - Country:US
Mailing Address - Phone:806-353-6100
Mailing Address - Fax:806-353-8130
Practice Address - Street 1:1213 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2057
Practice Address - Country:US
Practice Address - Phone:712-755-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019163208600000X
TXP7630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery