Basic Information
| Provider Information | |||||||||
| NPI: | 1891059929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOURYA | ||||||||
| FirstName: | RAJESH | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 956 COURT AVE | ||||||||
| Address2: | SUITE H314 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014485737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593238178 | ||||||||
| FaxNumber: | 8593238926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 06/19/2017 | ||||||||
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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 | 207R00000X | 6848 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 48013 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RC0200X | NA | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.