Provider Demographics
NPI:1285662510
Name:RAO, JAYASREE N (MD)
Entity Type:Individual
Prefix:
First Name:JAYASREE
Middle Name:N
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYASREE
Other - Middle Name:N
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 65057
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-5057
Mailing Address - Country:US
Mailing Address - Phone:210-299-8000
Mailing Address - Fax:210-979-0814
Practice Address - Street 1:202 BALTIMORE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1907
Practice Address - Country:US
Practice Address - Phone:210-290-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2452207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1815280403Medicaid
TXP00947300OtherRR MEDICARE
5032088OtherAETNA PIN#
TX1815280403Medicaid
I43485Medicare UPIN
TXP00947300OtherRR MEDICARE