Individual
JAYA KRISHNAMOORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1050 W ARKANSAS LN, ARLINGTON, TX 76013-6308
(817) 702-1100
(817) 702-4801
Mailing address
1412 MAY ST, FORT WORTH, TX 76104-7639
(817) 702-2450
(817) 702-8445
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036119470
IL
207R00000X
Internal Medicine Physician
Primary
N0373
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194635201
—
TX
05
—
194635203
—
TX
01
—
8BQ002
BCBS
TX
01
—
8EB685
BCBS
TX
01
—
P00919161
RAILROAD MEDICARE
TX
Enumeration date
01/02/2008
Last updated
04/13/2018
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