MEDICARE: DR. FNU BHARAT VED PRAKASH 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	207RP1001X	Pulmonary Disease Physician	MD 165973	OR
2	207RP1001X	Pulmonary Disease Physician	R3277	TX

General Provider Information

NPI Number	:	1912147125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FNU BHARAT VED PRAKASH MD

Provider Business Mailing Address
First Line	:	801 MISSION ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-6217
Country	:	US
Telephone Number	:	503-588-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000B TRANSMOUNTAIN RD STE B400
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3600
Country	:	US
Telephone Number	:	152-158-4009
Fax Number	:

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

Provider Enumeration Date	:	02/27/2009
Last Update Date	:	08/15/2021

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