Basic Information
| Provider Information | |||||||||
| NPI: | 1528267952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAYRAKTAR | ||||||||
| FirstName: | ULAS | ||||||||
| MiddleName: | DARDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3825 TEAYS VALLEY RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | HURRICANE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255269614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043884949 | ||||||||
| FaxNumber: | 3047577566 | ||||||||
| Practice Location | |||||||||
| Address1: | 3825 TEAYS VALLEY RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | HURRICANE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255269614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043884949 | ||||||||
| FaxNumber: | 3047577566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N5563 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 28598 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8CQ115 | 01 | TX | BCBS | OTHER | 215113601 | 05 | TX | MEDICAID |