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Individual

DR. JYOTI JAIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
6448 BROADWAY BLVD, GARLAND, TX 75043-5943
(972) 216-8500
(972) 216-8521
Mailing address
1209 CREEKWOOD DR, GARLAND, TX 75044-2421
(972) 216-8500
(972) 216-8521

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
J9110
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00T52V
BLUE SHIELD
TX
05
111658401
TX
01
75-2795302
TAX ID
TX
Enumeration date
08/12/2006
Last updated
04/18/2012
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