Provider Demographics
NPI:1316009806
Name:MEHTA, SANJAY C (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:C
Last Name:MEHTA
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 1:9150 S MAIN ST
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-3843
Mailing Address - Country:US
Mailing Address - Phone:713-630-8181
Mailing Address - Fax:
Practice Address - Street 1:9150 S MAIN ST
Practice Address - Street 2:SUITE A-3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3843
Practice Address - Country:US
Practice Address - Phone:713-630-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK93532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152402704Medicaid
TX8AA593OtherBCBS
TX152402706Medicaid
TX152402703Medicaid
TX152402705Medicaid
TX8J8479Medicare PIN
TX152402706Medicaid
TX152402703Medicaid
TX8AA593OtherBCBS
TX8J8478Medicare PIN