Provider Demographics
NPI:1730186230
Name:MEHTA, NIRAJ MAHENDRA (DO)
Entity type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:MAHENDRA
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8845 DAVIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0391
Mailing Address - Country:US
Mailing Address - Phone:817-900-9525
Mailing Address - Fax:817-900-9545
Practice Address - Street 1:8845 DAVIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0391
Practice Address - Country:US
Practice Address - Phone:817-900-9525
Practice Address - Fax:817-900-9545
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI21859Medicare UPIN
TX8C8640Medicare ID - Type Unspecified