Healthcare Provider Details

I. General information

NPI: 1407989270
Provider Name (Legal Business Name): AJAY BHARGAVA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 SW LEE BLVD
LAWTON OK
73505-8329
US

IV. Provider business mailing address

4302 SW LEE BLVD
LAWTON OK
73505-8329
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-0058
  • Fax: 580-248-7667
Mailing address:
  • Phone: 580-357-0058
  • Fax: 580-248-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number15053
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15054
License Number StateOK

VIII. Authorized Official

Name: MR. AJAY BHARGAVA
Title or Position: OWNER
Credential: MD
Phone: 580-357-0058