Provider Demographics
NPI:1992701940
Name:DESAI, RAJEN B (MD)
Entity type:Individual
Prefix:
First Name:RAJEN
Middle Name:B
Last Name:DESAI
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 1:3560 DELAWARE
Mailing Address - Street 2:STE 905
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-833-9662
Mailing Address - Fax:409-839-8864
Practice Address - Street 1:3560 DELAWARE
Practice Address - Street 2:STE 905
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-833-9662
Practice Address - Fax:409-839-8864
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2023-03-07
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXJ16492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0081410OtherDPS
TX123630902Medicaid
TXBD2260545OtherDEA
BD2260545OtherDEA
TXBD2260545OtherDEA