Basic Information
| Provider Information | |||||||||
| NPI: | 1639277353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDYA | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | BAKUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SHOAL CREEK BLVD | ||||||||
| Address2: | SUITE 205N | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787571098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064341 | ||||||||
| FaxNumber: | 5124071947 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W CENTRAL TEXAS EXPY | ||||||||
| Address2: | SUITE 355 | ||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765481899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545262085 | ||||||||
| FaxNumber: | 2545269569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N9478 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | N9478 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.