Provider Demographics
NPI:1063414985
Name:JAIN, MAHENDRA G (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:G
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8520 BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7716
Mailing Address - Country:US
Mailing Address - Phone:281-485-4050
Mailing Address - Fax:281-485-6850
Practice Address - Street 1:8520 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7716
Practice Address - Country:US
Practice Address - Phone:281-485-4050
Practice Address - Fax:281-485-6850
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK4317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040997105Medicaid
TX8FT489OtherBCBS
TX040997104Medicaid
TX8EB467OtherBCBS
TXP01316143OtherRR MEDICARE
TXP01626934OtherRR MEDICARE
TX040997103Medicaid
TX324474ZSWCMedicare PIN
TXG69002Medicare UPIN
TX324474YUD8Medicare PIN