Basic Information
| Provider Information | |||||||||
| NPI: | 1720464019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANJUA | ||||||||
| FirstName: | EJAZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 FANNIN ST STE 1101 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134410006 | ||||||||
| FaxNumber: | 7137902727 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 FANNIN ST STE 1101 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134410006 | ||||||||
| FaxNumber: | 7137902727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2015 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Q4933 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | Q4933 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 350240302 | 05 | TX | MEDICAID | 8FX390 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 350240301 | 05 | TX | MEDICAID | 8FJ009 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |