Provider Demographics
NPI:1720180433
Name:JEYARAJ, DARWIN DAVID SELWYN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARWIN
Middle Name:DAVID SELWYN
Last Name:JEYARAJ
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-5000
Mailing Address - Fax:417-347-6454
Practice Address - Street 1:3333 MCINTOSH CIR STE 4
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3681
Practice Address - Country:US
Practice Address - Phone:417-347-5000
Practice Address - Fax:417-347-6454
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084810207RC0000X
OK29757207RC0000X
MO2013015492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2501626Medicaid
OH2501626Medicaid
OHH065980Medicare PIN
OHJE7324841Medicare ID - Type Unspecified