Healthcare Provider Details

I. General information

NPI: 1649433780
Provider Name (Legal Business Name): JEET K. GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 NE LOOP 410 STE 405
SAN ANTONIO TX
78217-5675
US

IV. Provider business mailing address

7142 SAN PEDRO AVE STE 120
SAN ANTONIO TX
78216-6256
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-7326
  • Fax: 210-590-8232
Mailing address:
  • Phone: 210-661-5622
  • Fax: 210-395-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09497000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR3675
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: