Provider Demographics
NPI:1952509960
Name:JITENDRA N BHATT, MD, PA
Entity Type:Organization
Organization Name:JITENDRA N BHATT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-898-0232
Mailing Address - Street 1:1108 DALLAS DR STE 337
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5123
Mailing Address - Country:US
Mailing Address - Phone:940-898-0232
Mailing Address - Fax:
Practice Address - Street 1:1108 DALLAS DR STE 337
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-5123
Practice Address - Country:US
Practice Address - Phone:940-898-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0188RMedicare ID - Type UnspecifiedGROUP#
TXC13446Medicare UPIN