Provider Demographics
NPI:1821045600
Name:BHATLA, BRAJESH (MD)
Entity Type:Individual
Prefix:
First Name:BRAJESH
Middle Name:
Last Name:BHATLA
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 2835
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2835
Mailing Address - Country:US
Mailing Address - Phone:956-412-1125
Mailing Address - Fax:956-440-8854
Practice Address - Street 1:4402 E SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9290
Practice Address - Country:US
Practice Address - Phone:956-412-1125
Practice Address - Fax:956-440-8854
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9973207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8P5560OtherBLUE CROSS BLUE SHEILD
TX110742704Medicaid
TX8C0729Medicare PIN
TXG31369Medicare UPIN