Provider Demographics
NPI:1063613537
Name:AJIT DAVE', M.D., P.A.
Entity type:Organization
Organization Name:AJIT DAVE', M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIBEDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-382-4060
Mailing Address - Street 1:3327 COLORADO BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6865
Mailing Address - Country:US
Mailing Address - Phone:940-382-4060
Mailing Address - Fax:940-380-9282
Practice Address - Street 1:3327 COLORADO BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6865
Practice Address - Country:US
Practice Address - Phone:940-382-4060
Practice Address - Fax:940-380-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8687207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020ECOtherBCBS
TXTXB143454OtherMEDICARE PTAN
TXD56860OtherRR MEDICARE PTAN
TX314890001Medicaid
TXD56860OtherRR MEDICARE PTAN