1043364839 NPI number — VIJAY M. JOTWANI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043364839 NPI number — VIJAY M. JOTWANI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOTWANI

Provider First Name:

VIJAY

Provider Middle Name:

M.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1043364839

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/08/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3100 TIMMONS LN

Provider Second Line Business Mailing Address:

SUITE 120

Provider Business Mailing Address City Name:

HOUSTON

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

77027-5926

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

713-441-9000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

3100 TIMMONS LN

Provider Second Line Business Practice Location Address:

SUITE 120

Provider Business Practice Location Address City Name:

HOUSTON

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

77027-5926

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

713-441-9000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

01/22/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  MD00046265 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 01068588A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QS0010X , with the licence number: 01068588A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: P2270 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 331367801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: P01510480 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: P01110846 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 331367802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8DH104 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8DY923 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".