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NPI Code Detail

MEDICARE: DR. JYOTSNA S PRASAD MD

MEDICARE: DR. JYOTSNA S PRASAD 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
1207Q00000XFamily Medicine PhysicianL5100TX

Other Identifiers

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

General Provider Information

NPI Number : 1477571883
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTSNA S PRASAD MD
Provider Business Mailing Address
First Line : 820 S MACARTHUR BLVD STE 105-392
Second Line :
City : COPPELL
State : TX
Zip : 75019-4216
Country : US
Telephone Number : 972-900-0747
Fax Number : 972-393-5234
Provider Business Practice Location Address
First Line : 2428 BAHAMA DR
Second Line :
City : DALLAS
State : TX
Zip : 75211-2121
Country : US
Telephone Number : 972-900-0747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 12/22/2022

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