Provider Demographics
NPI:1407989270
Name:AJAY BHARGAVA MD INC
Entity Type:Organization
Organization Name:AJAY BHARGAVA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-357-0058
Mailing Address - Street 1:4302 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8329
Mailing Address - Country:US
Mailing Address - Phone:580-357-0058
Mailing Address - Fax:580-248-7667
Practice Address - Street 1:4302 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8329
Practice Address - Country:US
Practice Address - Phone:580-357-0058
Practice Address - Fax:580-248-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15054207V00000X
OK150532080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34403Medicare UPIN
C94686Medicare UPIN