Provider Demographics
NPI:1558338202
Name:VIJAPURA, DHVANIT K (MD)
Entity Type:Individual
Prefix:DR
First Name:DHVANIT
Middle Name:K
Last Name:VIJAPURA
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 1:2003 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7612
Mailing Address - Country:US
Mailing Address - Phone:850-784-9991
Mailing Address - Fax:850-763-8361
Practice Address - Street 1:2003 WILSON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4532
Practice Address - Country:US
Practice Address - Phone:850-784-9991
Practice Address - Fax:850-763-8361
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00593592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054221100Medicaid
FL12482OtherBCBS FLORIDA
FLE94937Medicare UPIN
FL054221100Medicaid