Provider Demographics
NPI:1720056849
Name:ROY, BAKUL T (MD)
Entity Type:Individual
Prefix:MR
First Name:BAKUL
Middle Name:T
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5601 NORRIS CANYON RD
Mailing Address - Street 2:STE. 340
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-866-8080
Mailing Address - Fax:925-866-8082
Practice Address - Street 1:5601 NORRIS CANYON RD.
Practice Address - Street 2:STE 340
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-866-8080
Practice Address - Fax:925-866-8082
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443180Medicaid
CAE24746Medicare UPIN
CAC83872Medicare PIN