Healthcare Provider Details

I. General information

NPI: 1962467050
Provider Name (Legal Business Name): AKSHAY S VAKHARIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S AUSTIN AVE STE 265
GEORGETOWN TX
78626
US

IV. Provider business mailing address

PO BOX 118455
CARROLLTON TX
75011-8455
US

V. Phone/Fax

Practice location:
  • Phone: 512-416-7246
  • Fax: 512-275-2833
Mailing address:
  • Phone: 214-774-2933
  • Fax: 866-396-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK1111
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036.146248
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK1111
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: