Healthcare Provider Details

I. General information

NPI: 1245525781
Provider Name (Legal Business Name): BABUR HAFEEZ BHATTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 BEACH BLVD
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

715 SEMINOLE RD
ATLANTIC BEACH FL
32233-5443
US

V. Phone/Fax

Practice location:
  • Phone: 904-724-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME125257
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME125257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: