Provider Demographics
NPI:1518925213
Name:BHUTA, AMAR V (MD)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:V
Last Name:BHUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 NE VANCOUVER MALL DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6172
Mailing Address - Country:US
Mailing Address - Phone:360-253-6947
Mailing Address - Fax:360-448-6324
Practice Address - Street 1:9430 NE VANCOUVER MALL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6172
Practice Address - Country:US
Practice Address - Phone:360-253-6947
Practice Address - Fax:360-448-6324
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 86395208M00000X
WAMD00043839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76709Medicare UPIN