Provider Demographics
NPI:1053338731
Name:BHACHAWAT, DEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:DEVEN
Middle Name:
Last Name:BHACHAWAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781905
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1905
Mailing Address - Country:US
Mailing Address - Phone:210-227-6156
Mailing Address - Fax:210-527-1446
Practice Address - Street 1:925 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4643
Practice Address - Country:US
Practice Address - Phone:210-227-6156
Practice Address - Fax:210-527-1446
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE76649Medicare UPIN
TX00269UMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER