=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932311958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASPAUL SINGH BHANGOO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3323 COLORADO BLVD SUITE 105
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-891-6066
-----------------------------------------------------
Fax | 940-891-0515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3323 COLORADO BLVD SUITE 105
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-891-6066
-----------------------------------------------------
Fax | 940-891-0515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | M5054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------