Provider Demographics
NPI:1982977781
Name:RANDHAWA, JEEWANJOT SINGH
Entity type:Individual
Prefix:
First Name:JEEWANJOT
Middle Name:SINGH
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6250
Mailing Address - Country:US
Mailing Address - Phone:210-344-7287
Mailing Address - Fax:210-239-1575
Practice Address - Street 1:7330 SAN PEDRO AVE STE 540
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6250
Practice Address - Country:US
Practice Address - Phone:210-344-7287
Practice Address - Fax:210-239-1575
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014025258207R00000X, 208M00000X
TXR1444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist