Provider Demographics
NPI:1760713424
Name:JAYASWAL, NISHANT SURENDRANATH (MD)
Entity Type:Individual
Prefix:
First Name:NISHANT
Middle Name:SURENDRANATH
Last Name:JAYASWAL
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 1:2400 N I 35
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5240
Mailing Address - Country:US
Mailing Address - Phone:469-843-4280
Mailing Address - Fax:469-843-4295
Practice Address - Street 1:2400 N I 35
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5240
Practice Address - Country:US
Practice Address - Phone:469-843-4280
Practice Address - Fax:469-843-4295
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071245207R00000X
TXN8309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282812101Medicaid
TX282812101Medicaid
TXP00980923Medicare PIN
TXTXB160115Medicare PIN
TX1760713424Medicare PIN
TXP01159218Medicare PIN
TXTXB131526Medicare PIN