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Individual

DR. ASHKAN BIDGOLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2700 E BROAD ST, MANSFIELD, TX 76063-5899
(682) 622-7139
Mailing address
1441 N BECKLEY AVE, DALLAS, TX 75203-1201
(214) 942-5733
(214) 942-6115

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M3162
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
176933301
TX
05
176933303
TX
05
176933305
TX
05
176933308
TX
01
8BT313
BCBS THRU SAEMA
TX
01
8G8522
MEDICARE
TX
01
8J1866
BCBS WITH AEMA
TX
01
8R3173
BCBS
TX
01
8W7098
BCBS
TX
01
P00038768
RR MEDICARE
TX
01
P01161489
RAILROAD MCARE
TX
Enumeration date
05/24/2006
Last updated
10/04/2013
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