Provider Demographics
NPI:1326036195
Name:JAIN, SURENDRA K (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
Middle Name:K
Last Name:JAIN
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 1:6624 FANNIN ST
Mailing Address - Street 2:STE 2320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-797-1111
Mailing Address - Fax:713-790-0008
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:STE 2320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-797-1111
Practice Address - Fax:713-790-0008
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7493207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4105257OtherAETNA
TX133733904Medicaid
4105257OtherAETNA
TX133733904Medicaid