Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | L6902 | TX |
N | 208600000X | Surgeon | L6902 | TX |
Y | 2086S0102X | Surgical Critical Care | L6902 | TX |
NPI | 1083634489 |
---|---|
Provider Name | Dr. Rajesh Ramesh Gandhi |
First Address | Dallas, TX 75373-2973 |
Second Address | Fort Worth, TX 76104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 13/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161563503 | (05) | TX |
P00413561 | RAILROAD MEDICARE (01) |