Provider Demographics
NPI:1003015421
Name:DHEVAN, VIJIAN (MD)
Entity Type:Individual
Prefix:
First Name:VIJIAN
Middle Name:
Last Name:DHEVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:2121 PEASE ST STE 101
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8321
Practice Address - Country:US
Practice Address - Phone:956-425-8845
Practice Address - Fax:956-364-6734
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3310208600000X
IL125-052980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08JE00001OtherBCBS
TX302849006Medicaid