Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 002219 | GA |
N | 208000000X | Pediatrician | P3798 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | P3798 | TX |
NPI | 1609053875 |
---|---|
Provider Name | Dr. Devika Radhika Rao |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002219 | GA TRAINING PERMIT NUMER (01) | GA |