Provider Demographics
NPI:1003018516
Name:JASPAUL S. BHANGOO, M.D., P.A,
Entity Type:Organization
Organization Name:JASPAUL S. BHANGOO, M.D., P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASPAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHANGOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-891-6066
Mailing Address - Street 1:3323 COLORADO BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-891-6066
Mailing Address - Fax:940-891-0515
Practice Address - Street 1:3323 COLORADO BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-891-6066
Practice Address - Fax:940-891-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095PSOtherBCBS
TX202190901Medicaid
TX202190901Medicaid