Provider Demographics
NPI:1992777320
Name:JAYARAM, KIRAN N (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:N
Last Name:JAYARAM
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 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:4411 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3824
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-2413
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5592207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118074707Medicaid
TXTXB112459OtherMEDICARE
TX8CM506OtherBCBS
TXP00898251OtherRAILROAD MEDICARE
TX118074707Medicaid
TXP00898251OtherRAILROAD MEDICARE
TXTXB112459Medicare PIN
TXG94287Medicare UPIN
TXTXB112459Medicare PIN
TXG94287Medicare UPIN