Healthcare Provider Details

I. General information

NPI: 1700814829
Provider Name (Legal Business Name): RAJESH BHAGAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPARTMENT OF MEDICINE DIVISION OF PULMONARY
JACKSON MS
39216-4500
US

IV. Provider business mailing address

P.O. BOX 24146 UNIVERSITY PHYSICIANS, PLLC
JACKSON MS
39225-4146
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5650
  • Fax:
Mailing address:
  • Phone: 601-984-5650
  • Fax: 601-984-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number17748
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: