Provider Demographics
NPI:1023851961
Name:BISTA, TEK BAHADUR (MD)
Entity type:Individual
Prefix:
First Name:TEK
Middle Name:BAHADUR
Last Name:BISTA
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 1:4801 ALBETA AVE, EL PASO, TX 79905
Mailing Address - Street 2:4801 ALBETA AVE, EL PASO, TX 79905
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-206-7641
Mailing Address - Fax:
Practice Address - Street 1:4801 ALBETA AVE, EL PASO, TX 79905
Practice Address - Street 2:4801 ALBETA AVE, EL PASO, TX 79905
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-206-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10090543390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program