Provider Demographics
NPI:1316965403
Name:PANDYA, RAJANIKANT P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJANIKANT
Middle Name:P
Last Name:PANDYA
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 1:22 PINON CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8570
Mailing Address - Country:US
Mailing Address - Phone:432-520-5678
Mailing Address - Fax:432-520-3684
Practice Address - Street 1:PREFERRED MEDICAL CENTER
Practice Address - Street 2:1200 ANDREWS HIGHWAY
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-520-5678
Practice Address - Fax:432-520-3684
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059ASMedicare PIN