Provider Demographics
NPI:1275702656
Name:BHAMBRI, SANJAY (DO)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:BHAMBRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7809
Mailing Address - Country:US
Mailing Address - Phone:469-757-4410
Mailing Address - Fax:469-277-3911
Practice Address - Street 1:3142 HORIZON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7809
Practice Address - Country:US
Practice Address - Phone:469-757-4410
Practice Address - Fax:469-277-3911
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6068207N00000X, 207ND0101X, 207NS0135X
TXN7906207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology