Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | L8896 | TX |
NPI | 1023187614 |
---|---|
Provider Name | Dr. Bharat Pothuri |
First Address | Cypress, TX 77429-5884 |
Second Address | Cypress, TX 77429-5884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 28/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167464001 | (05) | TX |
8W5340 | BLUE CROSS BLUE SHIELD NO (01) | TX |
I10032 | (02) | TX |