Provider Demographics
NPI:1659485092
Name:BHAKTA, PRANAV H (MD)
Entity Type:Individual
Prefix:MR
First Name:PRANAV
Middle Name:H
Last Name:BHAKTA
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-0220
Mailing Address - Country:US
Mailing Address - Phone:281-332-6650
Mailing Address - Fax:281-332-7588
Practice Address - Street 1:17448 HWY 3
Practice Address - Street 2:SUITE 160
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-332-6650
Practice Address - Fax:281-332-7588
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060ENOtherBCBS
TX096588101Medicaid
TX760639329OtherTAX ID
G76761Medicare UPIN
TX096588101Medicaid