Provider Demographics
NPI:1497719348
Name:RAVINDRAN, JAYARAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYARAMAN
Middle Name:
Last Name:RAVINDRAN
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 1:3120 MEDPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6982
Mailing Address - Country:US
Mailing Address - Phone:972-420-9200
Mailing Address - Fax:972-436-4088
Practice Address - Street 1:3120 MEDPARK DR
Practice Address - Street 2:STE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6981
Practice Address - Country:US
Practice Address - Phone:940-383-1770
Practice Address - Fax:940-566-2214
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ83552084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035981202Medicaid
TX00T31BMedicare PIN
TXG08615Medicare UPIN