Individual
DR. RAJIV DATTATREYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10260 N CENTRAL EXPY STE 100N, DALLAS, TX 75231-3437
(214) 363-5535
(214) 368-2760
Mailing address
2021 N MACARTHUR BLVD, STE 150, IRVING, TX 75061-2219
(972) 253-2560
(972) 253-4218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L0117
TX
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
L0117
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0375503 04
—
TX
05
—
037550303
—
TX
01
—
8 M2063
BC/BS
—
01
—
8J7489
MEDICARE NUMBER
TX
01
—
8L10293
MEDICARE PTAN
TX
Enumeration date
07/10/2006
Last updated
12/13/2021
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