Provider Demographics
NPI:1528239712
Name:SANJAY MISRA MD, PA
Entity type:Organization
Organization Name:SANJAY MISRA MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-270-9999
Mailing Address - Street 1:315 N. SAN SABA
Mailing Address - Street 2:SUITE 1175
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3155
Mailing Address - Country:US
Mailing Address - Phone:210-270-9999
Mailing Address - Fax:210-270-9952
Practice Address - Street 1:315 N. SAN SABA
Practice Address - Street 2:SUITE 1175
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3155
Practice Address - Country:US
Practice Address - Phone:210-270-9999
Practice Address - Fax:210-270-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110641105Medicaid
TX00505ZMedicare PIN