Provider Demographics
NPI:1154348977
Name:BEJJANKI, HANMANTH RAO (MD)
Entity type:Individual
Prefix:
First Name:HANMANTH
Middle Name:RAO
Last Name:BEJJANKI
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 1:203 WALLS DR STE 209
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7029
Mailing Address - Country:US
Mailing Address - Phone:817-648-0123
Mailing Address - Fax:888-253-6968
Practice Address - Street 1:203 WALLS DR STE 209
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-648-0123
Practice Address - Fax:888-253-6968
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0026207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH25131Medicare UPIN