Provider Demographics
NPI:1457453599
Name:OOMMEN, SANJAY P (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:P
Last Name:OOMMEN
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:500 S HENDERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2154
Practice Address - Country:US
Practice Address - Phone:174-131-5008
Practice Address - Fax:817-413-1499
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48004207R00000X
TXM0514207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ001OtherBCBSTX
MN926653000Medicaid
TXP00620588OtherRAILROAD MEDICARE
TX166168804Medicaid
TX166168802Medicaid
TX166168803Medicaid
TX8AQ001OtherBCBSTX
TXI10686Medicare UPIN
TX166168802Medicaid
TX8K6767Medicare PIN