Provider Demographics
NPI:1457524118
Name:ROOPAL BHATT MD, PA
Entity Type:Organization
Organization Name:ROOPAL BHATT MD, PA
Other - Org Name:FOUR POINTS DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROOPAL
Authorized Official - Middle Name:KS
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-478-3376
Mailing Address - Street 1:6618 SITIO DEL RIO BLVD STE D101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1148
Mailing Address - Country:US
Mailing Address - Phone:512-478-3376
Mailing Address - Fax:512-478-3375
Practice Address - Street 1:6618 SITIO DEL RIO BLVD
Practice Address - Street 2:BLDG D101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1143
Practice Address - Country:US
Practice Address - Phone:512-478-3376
Practice Address - Fax:512-478-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6049207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200288301Medicaid
I50344Medicare UPIN
TX200288301Medicaid