Provider Demographics
NPI:1578050571
Name:RICHARD, BHAVITHA GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAVITHA
Middle Name:GEORGE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7501 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5056
Mailing Address - Country:US
Mailing Address - Phone:918-710-4200
Mailing Address - Fax:
Practice Address - Street 1:1012 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2101
Practice Address - Country:US
Practice Address - Phone:719-383-5500
Practice Address - Fax:719-383-6533
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1578050571OtherNPI NUMBER