Provider Demographics
NPI:1043534589
Name:MOHAN, RAJA (MD)
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7777 FOREST LN STE C820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2552
Mailing Address - Country:US
Mailing Address - Phone:469-301-1725
Mailing Address - Fax:469-301-1769
Practice Address - Street 1:7777 FOREST LN STE C820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2552
Practice Address - Country:US
Practice Address - Phone:469-301-1725
Practice Address - Fax:469-301-1769
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDUNLICENSED208200000X
TXQ8960208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ8960OtherTMB FULL MEDICAL LICENSE