Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | L2563 | TX |
Y | 207PE0004X | Emergency Medical Services | L2563 | TX |
NPI | 1194773044 |
---|---|
Provider Name | Anuradha Prabhu |
First Address | Austin, TX 78746-1808 |
Second Address | Austin, TX 78704-6903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 14/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146447103 | (05) | TX |
146447104 | (05) | TX |
G76455 | (02) | TX |