Healthcare Provider Details

I. General information

NPI: 1790135572
Provider Name (Legal Business Name): CENTER FOR OSTEOPOROSIS AND BONE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 TRAVIS AVE # 104
FORT WORTH TX
76104-3184
US

IV. Provider business mailing address

928 TRAVIS AVE # 104
FORT WORTH TX
76104-3184
US

V. Phone/Fax

Practice location:
  • Phone: 682-286-1309
  • Fax: 817-635-8460
Mailing address:
  • Phone: 682-286-1309
  • Fax: 817-635-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberL9614
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberL9614
License Number StateTX

VIII. Authorized Official

Name: DR. GURPREET S. BAJAJ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 682-286-1309