Provider Demographics
NPI:1720768500
Name:GURJIT S DHATT MD PLLC
Entity Type:Organization
Organization Name:GURJIT S DHATT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GURJIT
Authorized Official - Middle Name:DHATT
Authorized Official - Last Name:DHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-872-8008
Mailing Address - Street 1:403 ATHERTON CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9439
Mailing Address - Country:US
Mailing Address - Phone:352-872-8008
Mailing Address - Fax:
Practice Address - Street 1:403 ATHERTON CIR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9439
Practice Address - Country:US
Practice Address - Phone:352-872-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty