Healthcare Provider Details

I. General information

NPI: 1184728362
Provider Name (Legal Business Name): VIJAY MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS BLVD CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM, DEPT SURGERY
TEMPLE TX
76501
US

IV. Provider business mailing address

4101 HICKORY RD
TEMPLE TX
76502-2909
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-0850
  • Fax:
Mailing address:
  • Phone: 254-774-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberF4957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: