Healthcare Provider Details

I. General information

NPI: 1861002941
Provider Name (Legal Business Name): JAYASREE RAO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BALTIMORE
SAN ANTONIO TX
78215-1907
US

IV. Provider business mailing address

202 BALTIMORE
SAN ANTONIO TX
78215-1907
US

V. Phone/Fax

Practice location:
  • Phone: 210-725-4646
  • Fax:
Mailing address:
  • Phone: 210-725-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYASREE RAO
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 210-725-4646