=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952509960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JITENDRA N BHATT, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1108 DALLAS DR STE 337
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76205-5123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-898-0232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1108 DALLAS DR STE 337
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76205-5123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-898-0232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JITENDRA N BHATT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 940-898-0232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E9539
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------