Provider Demographics
NPI:1255373619
Name:BAJAJ, GURPREET S (MD)
Entity type:Individual
Prefix:DR
First Name:GURPREET
Middle Name:S
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GURPREET
Other - Middle Name:S
Other - Last Name:BAJAJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:929 LIPSCOMB ST.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-926-2663
Mailing Address - Fax:817-293-8860
Practice Address - Street 1:929 LIPSCOMB ST.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-926-2663
Practice Address - Fax:817-293-8860
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9614207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171322401Medicaid
TX171322401Medicaid