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Organization
NAVJOT BAJWA MD PA
Active
Organization
NAVJOT BAJWA MD PA
Active
Other names
Children Medicaid Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NAVJOT BAJWA M.D. (PROVIDER)
(817) 623-2012
Entity
Organization
Contact information
Practice address
11751 ALTA VISTA RD, SUITE 103, FORT WORTH, TX 76244-6407
(817) 623-2012
(817) 623-2009
Mailing address
11751 ALTA VISTA RD, SUITE 103, FORT WORTH, TX 76244-6407
(817) 623-2012
(817) 623-2009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K5790
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281353701
—
TX
01
—
281353702
MEDICAID EP1
—
Enumeration date
05/27/2010
Last updated
09/04/2014
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