Provider Demographics
NPI:1871575688
Name:AGARWAL, SANJAY (MD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5722 ESPLANADE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4227
Mailing Address - Country:US
Mailing Address - Phone:361-980-1115
Mailing Address - Fax:361-980-3999
Practice Address - Street 1:5722 ESPLANADE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4227
Practice Address - Country:US
Practice Address - Phone:361-980-1115
Practice Address - Fax:361-980-3999
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3960207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164449401Medicaid
TX164449401Medicaid
TXF01544Medicare UPIN