Healthcare Provider Details

I. General information

NPI: 1962841155
Provider Name (Legal Business Name): BHAVESH JOSHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 DEVALL DR STE 201
AUBURN AL
36832-6655
US

IV. Provider business mailing address

PO BOX 119
STATE UNIVERSITY AR
72467-0119
US

V. Phone/Fax

Practice location:
  • Phone: 334-887-8707
  • Fax: 334-887-8706
Mailing address:
  • Phone: 860-680-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS018106
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO.2905
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: