Healthcare Provider Details

I. General information

NPI: 1417980806
Provider Name (Legal Business Name): GIRISH R. BHATT, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W GROVE ST
EL DORADO AR
71730-4416
US

IV. Provider business mailing address

PO BOX 11390
EL DORADO AR
71730-0033
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-0333
  • Fax: 870-864-9680
Mailing address:
  • Phone: 870-863-0333
  • Fax: 870-864-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE4582
License Number StateAR

VIII. Authorized Official

Name: GIRISH R BHATT
Title or Position: OWNER
Credential: MD
Phone: 870-863-0333