MEDICARE: ANANT K DHAVALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	M6105	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8V9071	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1467416404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANANT K DHAVALE MD

Provider Business Mailing Address
First Line	:	2403 N LAURENT ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-4119
Country	:	US
Telephone Number	:	361-579-0315
Fax Number	:	361-579-0325

Provider Business Practice Location Address
First Line	:	1501 BURNET RD
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-8520
Country	:	US
Telephone Number	:	325-649-3307
Fax Number	:	325-645-5459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/11/2008

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