MEDICARE: DR. DEVEN BHACHAWAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	K3990	TX

General Provider Information

NPI Number	:	1053338731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVEN BHACHAWAT MD

Provider Business Mailing Address
First Line	:	PO BOX 781905
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78278-1905
Country	:	US
Telephone Number	:	210-227-6156
Fax Number	:	210-527-1446

Provider Business Practice Location Address
First Line	:	925 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4643
Country	:	US
Telephone Number	:	210-227-6156
Fax Number	:	210-527-1446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/16/2007

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