Provider Demographics
NPI:1376838771
Name:BAYSSA, EYERUSALEM ENGIDA (MD)
Entity type:Individual
Prefix:DR
First Name:EYERUSALEM
Middle Name:ENGIDA
Last Name:BAYSSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:3800 GAYLORD PKWY STE 910
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9419
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:972-685-4881
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2053207RN0300X, 207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR2053OtherTEXAS MEDICAL BOARD