Provider Demographics
NPI:1336166982
Name:JAYANTY, VIKRAM S (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:S
Last Name:JAYANTY
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 1:10837 KATY FWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2207
Mailing Address - Country:US
Mailing Address - Phone:713-932-9200
Mailing Address - Fax:713-932-6152
Practice Address - Street 1:10837 KATY FWY
Practice Address - Street 2:SUITE 175
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2207
Practice Address - Country:US
Practice Address - Phone:713-932-9200
Practice Address - Fax:713-932-6152
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4609207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0972812-02Medicaid
TXB23741Medicare UPIN
TX0972812-02Medicaid