Provider Demographics
NPI:1386720860
Name:BHUTA, DHARAMPAL (MD)
Entity type:Individual
Prefix:DR
First Name:DHARAMPAL
Middle Name:
Last Name:BHUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DP
Other - Middle Name:
Other - Last Name:BHUTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:345 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7103
Mailing Address - Country:US
Mailing Address - Phone:334-279-5737
Mailing Address - Fax:334-279-1048
Practice Address - Street 1:345 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7103
Practice Address - Country:US
Practice Address - Phone:334-279-5737
Practice Address - Fax:334-279-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD8878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC 76415Medicare UPIN