Provider Demographics
NPI:1033262605
Name:CHOUHAN, RAJENDRA SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:SINGH
Last Name:CHOUHAN
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 1:1115 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2153
Mailing Address - Country:US
Mailing Address - Phone:817-335-7803
Mailing Address - Fax:817-335-6451
Practice Address - Street 1:1115 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2153
Practice Address - Country:US
Practice Address - Phone:817-335-7803
Practice Address - Fax:817-335-6451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9158208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0323156-01Medicaid
TX0323156-01Medicaid
TX00BP78Medicare PIN