Provider Demographics
NPI:1427580018
Name:BHAKTA, JAYEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYEN
Middle Name:M
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207830
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7830
Mailing Address - Country:US
Mailing Address - Phone:888-412-2649
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:6473 KINGSTON PIKE STE 6473
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4832
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:865-588-8841
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN67626207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC227588OtherNORTH CAROLINA MEDICAL BOARD