Provider Demographics
NPI:1992042782
Name:ELANGO VINJIRAYER, M.D., P.A.
Entity Type:Organization
Organization Name:ELANGO VINJIRAYER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-237-7032
Mailing Address - Street 1:4235 HOLLAND AVE APT C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5913
Mailing Address - Country:US
Mailing Address - Phone:214-329-1281
Mailing Address - Fax:817-622-8068
Practice Address - Street 1:4235 HOLLAND AVE APT C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5913
Practice Address - Country:US
Practice Address - Phone:214-329-1281
Practice Address - Fax:817-622-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty