Healthcare Provider Details

I. General information

NPI: 1114057544
Provider Name (Legal Business Name): BHASKAR RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GATEWAY BLVD W
EL PASO TX
79925-7701
US

IV. Provider business mailing address

4849 N. MESA SUITE 201
EL PASO TX
79912
US

V. Phone/Fax

Practice location:
  • Phone: 915-455-2266
  • Fax: 866-864-8671
Mailing address:
  • Phone: 915-455-2266
  • Fax: 866-864-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4301509824
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberP4501
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP4501
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4501
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberP4501
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24241
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: