1679528467 NPI number — RAJESH GOGIA M.D.

Table of content: RAJESH GOGIA M.D. (NPI 1679528467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679528467 NPI number — RAJESH GOGIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOGIA
Provider First Name:
RAJESH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1679528467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2140 E SOUTHLAKE BLVD
Provider Second Line Business Mailing Address:
STE L-309
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-502-8157
Provider Business Mailing Address Fax Number:
972-739-1468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 MATLOCK RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76015-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-502-8157
Provider Business Practice Location Address Fax Number:
972-739-1468
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  M5724 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 057464 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00670157 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147305774C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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