Provider Demographics
NPI:1053840017
Name:TEXAS GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:TEXAS GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HANMANTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEJJANKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-994-5786
Mailing Address - Street 1:6809 SAUCON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-7125
Mailing Address - Country:US
Mailing Address - Phone:817-994-5786
Mailing Address - Fax:
Practice Address - Street 1:203 WALLS DR STE 209
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-648-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0026207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty