Provider Demographics
NPI:1871593103
Name:SINGH, SAURABH (MD)
Entity type:Individual
Prefix:
First Name:SAURABH
Middle Name:
Last Name:SINGH
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 1:300 MARVIN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3480
Mailing Address - Country:US
Mailing Address - Phone:409-383-1355
Mailing Address - Fax:409-384-7278
Practice Address - Street 1:300 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3480
Practice Address - Country:US
Practice Address - Phone:409-383-1355
Practice Address - Fax:409-384-7278
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122133505Medicaid
F69429Medicare UPIN
TX8144NOMedicare PIN