Healthcare Provider Details

I. General information

NPI: 1205909074
Provider Name (Legal Business Name): HANS JAMES RAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 N VON MINDEN ST
LA GRANGE TX
78945-1262
US

IV. Provider business mailing address

1253 N VON MINDEN ST
LA GRANGE TX
78945-1262
US

V. Phone/Fax

Practice location:
  • Phone: 979-968-8493
  • Fax: 979-968-6388
Mailing address:
  • Phone: 979-968-8493
  • Fax: 979-968-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-42702
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014006061
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036147144
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM1301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: