Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | J2627 | TX |
N | 207R00000X | Internist | J2627 | TX |
N | 111NI0900X | Internist | J2627 | TX |
NPI | 1013913623 |
---|---|
Provider Name | Dr. Laxman R Kalvakuntla |
First Address | Nacogdoches, TX 75965-8717 |
Second Address | Nacogdoches, TX 75965-8717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00J23M | MEDICARE ID (01) | TX |
1303655301 | (05) | TX |
F35966 | (02) | TX |