Provider Demographics
NPI:1346246964
Name:VYAS, KAVITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:S
Last Name:VYAS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:607 RUSSELL BLVD
Mailing Address - Street 2:A
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1247
Mailing Address - Country:US
Mailing Address - Phone:936-560-2920
Mailing Address - Fax:866-861-6312
Practice Address - Street 1:607 RUSSELL BLVD
Practice Address - Street 2:A
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1247
Practice Address - Country:US
Practice Address - Phone:936-560-2920
Practice Address - Fax:866-861-6312
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9697207R00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043017501Medicaid
TX043017501Medicaid
TXH27634Medicare UPIN
TX043017501Medicaid