Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 642971 | TX |
NPI | 1043664386 |
---|---|
Provider Name | Dr. Deepak Kumar Pruthi |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 23/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
365582101 | (05) | TX |
365582102 | CSHCN (01) | TX |
545607YK00 | (02) | TX |