Healthcare Provider Details

I. General information

NPI: 1255414157
Provider Name (Legal Business Name): RAJESH M. MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9312 BRODIE LN
AUSTIN TX
78748-5176
US

IV. Provider business mailing address

PO BOX 161328
AUSTIN TX
78716-1328
US

V. Phone/Fax

Practice location:
  • Phone: 512-368-5294
  • Fax: 512-368-5289
Mailing address:
  • Phone: 512-368-5294
  • Fax: 512-368-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN0270
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35062919
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number16787
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number35062919
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number16787
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: