Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | M9860 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | M9860 | TX |
NPI | 1245453166 |
---|---|
Provider Name | Kamran Bhatti |
First Address | Waxahachie, TX 75165-5240 |
Second Address | Waxahachie, TX 75165-5240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 06/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1946972-09 | (05) | TX |
8K5178 | BCBS (01) | TX |