Provider Demographics
NPI:1972524197
Name:AKOTIA, VIMESH B (MD)
Entity type:Individual
Prefix:DR
First Name:VIMESH
Middle Name:B
Last Name:AKOTIA
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST
Practice Address - Street 2:STE 550
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8369
Practice Address - Country:US
Practice Address - Phone:903-510-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65232207RG0100X
NMMD2007-0010207RG0100X
TXP7375207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00418207OtherRAILROAD MEDICARE
TXP01002082OtherRAILROAD MEDICARE
CA00A652320Medicaid
NMNM002C08OtherBCBS
NM96735091Medicaid
TX8DY841OtherBCBS
NM34M716202Medicare PIN
CAG88248Medicare UPIN
NMNM002C08OtherBCBS