Provider Demographics
NPI:1568470797
Name:JAIN, ANJALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:713-272-8884
Mailing Address - Fax:713-272-0898
Practice Address - Street 1:6776 SOUTHWEST FWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-272-8884
Practice Address - Fax:713-272-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8173208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF8173OtherMEDICAL LICENSE
TX136172704Medicaid
TX085680901Medicaid
TX00U52QMedicare PIN