Healthcare Provider Details

I. General information

NPI: 1316145352
Provider Name (Legal Business Name): ARJUN JAYARAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 401
JACKSON MS
39216-4607
US

IV. Provider business mailing address

971 LAKELAND DR STE 401
JACKSON MS
39216-4607
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-4230
  • Fax: 601-664-6694
Mailing address:
  • Phone: 601-939-4230
  • Fax: 601-664-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML20008974
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number56930
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number106982
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number24055
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: