MEDICARE: JEET K. GANDHI 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	207R00000X	Internal Medicine Physician	25MA09497000	NJ
2	207RN0300X	Nephrology Physician	R3675	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

General Provider Information

NPI Number	:	1649433780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEET K. GANDHI MD

Provider Business Mailing Address
First Line	:	7142 SAN PEDRO AVE STE 120
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6256
Country	:	US
Telephone Number	:	210-661-5622
Fax Number	:	210-395-4012

Provider Business Practice Location Address
First Line	:	2391 NE LOOP 410 STE 405
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5675
Country	:	US
Telephone Number	:	210-654-7326
Fax Number	:	210-590-8232

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	08/19/2021

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