Healthcare Provider Details

I. General information

NPI: 1073142204
Provider Name (Legal Business Name): RAJA UMAIR ULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR FL 2
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

4502 MEDICAL DR FL 2
SAN ANTONIO TX
78229-4402
US

V. Phone/Fax

Practice location:
  • Phone: 210-743-2900
  • Fax: 210-702-6288
Mailing address:
  • Phone: 210-743-2900
  • Fax: 210-702-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36289
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberV7091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: