Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 01058767A | IN |
NPI | 1023067477 |
---|---|
Provider Name | Ajay Jain |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 43202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200471530A | (05) | IN |
I08711 | (02) |