Provider Demographics
NPI:1790746683
Name:JERE, SUJATA H (MD)
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:H
Last Name:JERE
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 1:2400 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5378
Mailing Address - Country:US
Mailing Address - Phone:512-901-4026
Mailing Address - Fax:512-901-3867
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4026
Practice Address - Fax:512-901-3867
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00463326OtherRRMDCR
TX178189001Medicaid
TXH39098Medicare UPIN
TXP00463326OtherRRMDCR
TX267215YNBVMedicare PIN