Organization
FEDERICO VALDERRAMA-BAZAN, M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FEDERICO VALDERRAMA-BAZAN M.D. (PRESIDENT)
(409) 839-4757
Entity
Organization
Contact information
Practice address
810 HOSPITAL DR, SUITE 320, BEAUMONT, TX 77701-4600
(409) 839-4757
(409) 839-4294
Mailing address
810 HOSPITAL DR, SUITE 320, BEAUMONT, TX 77701-4600
(409) 839-4757
(409) 839-4294
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E3488
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123414807
—
TX
05
—
172224101
—
TX
Enumeration date
11/21/2006
Last updated
09/24/2010
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