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NPI Code Detail

MEDICARE: DEEPAK RAJ

MEDICARE:   DEEPAK  RAJ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianT-5157MS
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1174227714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEPAK RAJ
Provider Business Mailing Address
First Line : 4500 13TH ST
Second Line :
City : GULFPORT
State : MS
Zip : 39501-2515
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4500 13TH ST
Second Line :
City : GULFPORT
State : MS
Zip : 39501-2515
Country : US
Telephone Number : 228-822-6512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 05/26/2026

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Directions to “ DEEPAK RAJ ” Practice Location

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