Provider Demographics
NPI:1265727697
Name:PASSI, JATINDER PAL (MD)
Entity type:Individual
Prefix:
First Name:JATINDER
Middle Name:PAL
Last Name:PASSI
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 1:3919 BARNETT RD
Mailing Address - Street 2:# 1022
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1725
Mailing Address - Country:US
Mailing Address - Phone:214-566-9231
Mailing Address - Fax:
Practice Address - Street 1:3919 BARNETT RD
Practice Address - Street 2:# 1022
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1725
Practice Address - Country:US
Practice Address - Phone:214-566-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine