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General NPI Number Information
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NPI Number | 1194733626
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Entity Type | Organization
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Legal Business Name | B RAI MEHTA, MD PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 3295 S COOPER ST 137
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City | ARLINGTON
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State | TX
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Zip | 76015-2363
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Country | US
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Telephone | 817-417-0973
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Fax | 817-417-7266
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Provider Business Mailing Address
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Address Line | 3295 S COOPER ST 137
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City | ARLINGTON
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State | TX
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Zip | 76015-2363
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Country | US
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Telephone | 817-417-0973
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Fax | 817-417-7266
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SHELLY ANN IRVING
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Credential |
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Telephone | 817-417-0973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 452592
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License Number State | TX
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