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General NPI Number Information
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NPI Number | 1336417039
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Entity Type | Organization
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Legal Business Name | JYOTI JAIN, MD, PA
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 6448 BROADWAY BLVD
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City | GARLAND
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State | TX
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Zip | 75043-5943
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Country | US
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Telephone | 972-216-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 6448 BROADWAY BLVD
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City | GARLAND
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State | TX
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Zip | 75043-5943
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Country | US
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Telephone | 972-216-8500
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JYOTI JAIN
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Credential | M.D., P.A.
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Telephone | 972-216-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | J9110
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 717114
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J9110
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License Number State | TX
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