Provider Demographics
NPI:1780617282
Name:MOORJANI, GAUTAM R (MD)
Entity type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:R
Last Name:MOORJANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19272 STONE OAK PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-265-8851
Mailing Address - Fax:210-265-8855
Practice Address - Street 1:19272 STONE OAK PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-265-8851
Practice Address - Fax:210-265-8855
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM20040814208M00000X
TXN0997207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57579733Medicaid
NM347536103Medicare ID - Type Unspecified
NM57579733Medicaid