Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 27625 | TX |
NPI | 1073771838 |
---|---|
Provider Name | Dr. Nitin Uddaraju Raju |
First Address | San Antonio, TX 78240-1865 |
Second Address | San Antonio, TX 78212-2430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 17/04/2015 |