Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G8687 | TX |
NPI | 1043291347 |
---|---|
Provider Name | Dr. Ajit M Dave |
First Address | Denton, TX 76210-6865 |
Second Address | Denton, TX 76210-6865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 05/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0020EC | BLUE CROSS BLUE SHIELD (01) | TX |
0800070588 | RAILROAD MEDICARE (01) | TX |
121386005 | (05) | TX |
C15030 | (02) | TX |