Provider Demographics
NPI:1497903975
Name:VIKRAM S. JAYANTY,M.D.,PA
Entity Type:Organization
Organization Name:VIKRAM S. JAYANTY,M.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAYANTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-932-9200
Mailing Address - Street 1:10837 KATY FWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2207
Mailing Address - Country:US
Mailing Address - Phone:713-932-9200
Mailing Address - Fax:713-932-6152
Practice Address - Street 1:10837 KATY FWY
Practice Address - Street 2:SUITE 175
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2207
Practice Address - Country:US
Practice Address - Phone:713-932-9200
Practice Address - Fax:713-932-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4609207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097281202Medicaid
TX00Z681Medicare PIN
TXB23741Medicare UPIN