Provider Demographics
NPI:1083606842
Name:JAIN, DEVENDRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 MAIN ST
Mailing Address - Street 2:PO BOX 236
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2649
Mailing Address - Country:US
Mailing Address - Phone:620-421-3392
Mailing Address - Fax:620-421-5745
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2649
Practice Address - Country:US
Practice Address - Phone:620-421-3392
Practice Address - Fax:620-421-5745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04261102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS628180OtherFIRSTGUARD
KS040850OtherBLUE CROSS BLUE SHIELD
KS040850OtherBLUE CROSS BLUE SHIELD
KS040850Medicare ID - Type Unspecified