Healthcare Provider Details

I. General information

NPI: 1205835022
Provider Name (Legal Business Name): BHUPESH HASMUKH DIHENIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 23RD ST
LUBBOCK TX
79410
US

IV. Provider business mailing address

3815 23RD ST
LUBBOCK TX
79410-1809
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-3500
  • Fax: 806-796-0689
Mailing address:
  • Phone: 806-722-3500
  • Fax: 806-796-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK3156
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: