Gautam, Manjushree
Gautam, Manjushree is an individual health care provider with primary practice located at 1250 8Th Ave Suite 515, Fort Worth TX 76104-4124. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hepatology, Allopathic & Osteopathic Physicians / Gastroenterology, Allopathic & Osteopathic Physicians / Transplant Hepatology. Allopathic & Osteopathic Physicians / Gastroenterology is her primary health care specialty. Gautam, Manjushree can be contacted via phone (817) 922-4675.Contact Information
Primary practice address
1250 8Th Ave Suite 515
Fort Worth TX 76104-4124
Phone: (817) 922-4675
Fax: (817) 922-4645
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hepatology | 207RI0008X | 33778 | Arizona |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | N6309 | Texas |
| Allopathic & Osteopathic Physicians / Transplant Hepatology | 207RT0003X | N6309 | Texas |
Profile Details
| NPI number | 1831172725 |
|---|---|
| LBN Legal business name | Gautam, Manjushree |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 23rd, 2005 |
| Last updated | Jul 21st, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831172725 | NPPES |
| Texas | Other | 8BN847 | BCBSTX |
| Texas | MEDICAID | 217199301 | BCBSTX |
| Texas | MEDICAID | 935554 | BCBSTX |
| Texas | Other | 86080015085259D008 | BCBSTX |
| Texas | Other | P00278312 | BCBSTX |
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