1407556871 NPI number — PRANAV BHATT, MD, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407556871 NPI number — PRANAV BHATT, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRANAV BHATT, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407556871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3410 ESPLANADE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77707-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-239-5605
Provider Business Mailing Address Fax Number:
409-239-5763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3129 COLLEGE ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-239-5605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BHATT
Authorized Official First Name:
PRANAV
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
409-239-5605

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)