Healthcare Provider Details

I. General information

NPI: 1487615084
Provider Name (Legal Business Name): BHAGWAN D BANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PAULK AVE SUITE A
OPP AL
36467-1727
US

IV. Provider business mailing address

PO BOX 509
OPP AL
36467-0509
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-2400
  • Fax: 334-493-3261
Mailing address:
  • Phone: 334-493-2400
  • Fax: 334-493-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00020322
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: