Healthcare Provider Details

I. General information

NPI: 1073755823
Provider Name (Legal Business Name): BHAVANA BABBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 TEEL PKWY STE 200
FRISCO TX
75033-2057
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-6272
  • Fax: 214-618-6277
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-885-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN1540
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: