Provider Demographics
NPI:1881904027
Name:PRANAV H BHAKTA MD PA
Entity type:Organization
Organization Name:PRANAV H BHAKTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRANAV
Authorized Official - Middle Name:H
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-6650
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-0220
Mailing Address - Country:US
Mailing Address - Phone:281-332-6650
Mailing Address - Fax:281-332-7588
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:#160
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4197
Practice Address - Country:US
Practice Address - Phone:281-332-6650
Practice Address - Fax:281-332-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty