Individual
DR. SIDDHARTH GULABCHAND JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2705 PRINCE GEORGE AVE, DESOTO, TX 75115-2045
(972) 780-0480
(972) 780-1453
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M9374
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196816601
—
TX
05
—
196816602
—
TX
05
—
34303400
—
WI
01
—
8A9487
BLUE CROSS BLUE SHIELD
TX
01
—
P00615680
RAILROAD MEDICARE
TX
01
—
P01322832
RAILROAD MEDICARE
TX
Enumeration date
09/14/2006
Last updated
08/15/2014
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