Provider Demographics
NPI:1790787612
Name:MEHTA, BHASKER RAI (MD)
Entity Type:Individual
Prefix:
First Name:BHASKER
Middle Name:RAI
Last Name:MEHTA
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 1:3295 S COOPER ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3295 S COOPER ST
Practice Address - Street 2:SUITE 131
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2363
Practice Address - Country:US
Practice Address - Phone:817-557-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9815174400000X, 207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122527803Medicaid
TX122527803Medicaid