Provider Demographics
NPI:1457513103
Name:BHAVSAR, JENNIFER ANN-NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN-NICOLE
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 S TEXAS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:979-774-2060
Mailing Address - Fax:979-776-5914
Practice Address - Street 1:4421 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6171
Practice Address - Country:US
Practice Address - Phone:979-690-4475
Practice Address - Fax:979-690-4476
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31012207Q00000X
TXP4422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307554102Medicaid