Healthcare Provider Details

I. General information

NPI: 1386323145
Provider Name (Legal Business Name): PUJA BHANDARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W. PARK DRIVE
LIVINGSTON TX
77351
US

IV. Provider business mailing address

204 W. PARK DRIVE
LIVINGSTON TX
77351
US

V. Phone/Fax

Practice location:
  • Phone: 936-327-4660
  • Fax: 936-327-4661
Mailing address:
  • Phone: 936-327-4660
  • Fax: 936-327-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW5740
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: