Healthcare Provider Details

I. General information

NPI: 1013197805
Provider Name (Legal Business Name): JAIDEEP U. BARGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W TIDWELL RD STE 103
HOUSTON TX
77040-5719
US

IV. Provider business mailing address

7600 W TIDWELL RD STE 103
HOUSTON TX
77040-5719
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-3573
  • Fax:
Mailing address:
  • Phone: 713-461-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberN8165
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberN8165
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: