MEDICARE: DR. SANJAY C MEHTA MD

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
1	2085R0001X	Radiation Oncology Physician	K9353	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AA593	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316009806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY C MEHTA MD

Provider Business Mailing Address
First Line	:	9150 S MAIN ST
Second Line	:	SUITE A-3
City	:	HOUSTON
State	:	TX
Zip	:	77025-3843
Country	:	US
Telephone Number	:	713-630-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 S MAIN ST
Second Line	:	SUITE A-3
City	:	HOUSTON
State	:	TX
Zip	:	77025-3843
Country	:	US
Telephone Number	:	713-630-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/25/2012

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