Provider Demographics
NPI:1003836271
Name:NARAYANA, JAYAPRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:JAYAPRAKASH
Middle Name:
Last Name:NARAYANA
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 1:4500 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5644
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:101 N HOUSTON ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1950
Practice Address - Country:US
Practice Address - Phone:972-932-7001
Practice Address - Fax:972-932-7007
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035133003Medicaid
TX035133004Medicaid
TX035133001Medicaid
TX035133002Medicaid
TX035133005Medicaid
TX00N95ZMedicare ID - Type Unspecified
TX8J9755Medicare PIN
TX8K3555Medicare PIN
TX8J9738Medicare PIN
TX8J9447Medicare PIN
TX035133003Medicaid
TX035133004Medicaid