Healthcare Provider Details

I. General information

NPI: 1750918389
Provider Name (Legal Business Name): DR. RAJIV HEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 550 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-3018
US

IV. Provider business mailing address

2665 SCRIPTURE ST
DENTON TX
76201-2695
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4661
  • Fax:
Mailing address:
  • Phone: 940-222-6900
  • Fax: 940-222-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberW4111
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: