Organization
JYOTI JAIN, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JYOTI JAIN M.D., P.A. (OWNER/PHYSICIAN)
(972) 216-8500
Entity
Organization
Contact information
Practice address
6448 BROADWAY BLVD, GARLAND, TX 75043-5943
(972) 216-8500
Mailing address
6448 BROADWAY BLVD, GARLAND, TX 75043-5943
(972) 216-8500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J9110
TX
2080A0000X
Pediatric Adolescent Medicine Physician
J9110
TX
363LP0200X
Pediatric Nurse Practitioner
717114
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111658401
DR JAIN TPI
TX
01
—
1508151994
NICOLE NPI
—
01
—
1932111945
DR JAIN NPI
—
01
—
717114
NICOLE LICENSE
TX
01
—
J9110
DR JAIN LICENSE
TX
Enumeration date
12/08/2011
Last updated
04/17/2012
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