Provider Demographics
NPI:1568494557
Name:JAYARAM, T H (MD)
Entity Type:Individual
Prefix:
First Name:T
Middle Name:H
Last Name:JAYARAM
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 1:9950 MEMORIAL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4282
Mailing Address - Country:US
Mailing Address - Phone:281-446-6803
Mailing Address - Fax:281-446-0449
Practice Address - Street 1:9950 MEMORIAL
Practice Address - Street 2:SUITE 102
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4282
Practice Address - Country:US
Practice Address - Phone:281-446-6803
Practice Address - Fax:281-446-0449
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4610207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127928504Medicaid
TX81Y870Medicare ID - Type Unspecified
TX127928504Medicaid