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General NPI Number Information
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NPI Number | 1992042782
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Entity Type | Organization
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Legal Business Name | ELANGO VINJIRAYER, M.D., P.A.
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 4235 HOLLAND AVE APT C
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City | DALLAS
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State | TX
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Zip | 75219-5913
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Country | US
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Telephone | 214-329-1281
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Fax | 817-622-8068
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Provider Business Mailing Address
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Address Line | 4235 HOLLAND AVE APT C
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City | DALLAS
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State | TX
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Zip | 75219-5913
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Country | US
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Telephone | 214-329-1281
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Fax | 817-622-8068
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JILL BOETH
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Credential |
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Telephone | 682-237-7032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N4184
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License Number State | TX
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