Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | J6669 | TX |
Y | 208600000X | Surgeon | J6669 | TX |
N | 2086S0102X | Surgical Critical Care | J6669 | TX |
NPI | 1093756975 |
---|---|
Provider Name | Anant Chelva Praba |
First Address | La Grange, TX 78945-1250 |
Second Address | La Grange, TX 78945-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043958001 | (05) | TX |
H03176 | (02) | TX |