Provider Demographics
NPI:1083616700
Name:AHUJA, JAGBIR K (MD)
Entity Type:Individual
Prefix:
First Name:JAGBIR
Middle Name:K
Last Name:AHUJA
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 1:100 W CENTRAL TEXAS EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7469
Mailing Address - Country:US
Mailing Address - Phone:254-618-4933
Mailing Address - Fax:254-618-1191
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY STE 290
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1991
Practice Address - Country:US
Practice Address - Phone:254-618-1151
Practice Address - Fax:254-618-1158
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3255207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360959594Medicaid
IL100010491OtherMEDICARE RAILROAD
ILG28587Medicare UPIN
ILK27125Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
ILK27126Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID