Provider Demographics
NPI:1780976191
Name:VYAS, JAY RAJEN (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:RAJEN
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 PLAZA VIA
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3224
Mailing Address - Country:US
Mailing Address - Phone:501-247-6003
Mailing Address - Fax:
Practice Address - Street 1:12332 BEAR PLZ
Practice Address - Street 2:STE 100
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0283
Practice Address - Country:US
Practice Address - Phone:682-285-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5220207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136975Medicaid