Provider Demographics
NPI:1881871754
Name:BHAVSAR, ASHISH ASHOK (MD)
Entity type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:ASHOK
Last Name:BHAVSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:STE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:714-639-4105
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:STE 410
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-639-9401
Practice Address - Fax:714-639-4105
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117360208M00000X, 207Q00000X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912919804OtherTYPE 2 NPI
CACG5665OtherRAIL ROAD MEDICARE GROUP PTAN
CAA117360OtherMEDICAL LICENSE NUMBER
CAP01292528OtherRAIL ROAD MEDICARE PROVIDER PTAN
CA1912919804OtherTYPE 2 NPI
CAW1514Medicare PIN