Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | K9446 | TX |
NPI | 1083671796 |
---|---|
Provider Name | Dr. Purnima Venkatesh |
First Address | Bedford, TX 76022-6111 |
Second Address | Bedford, TX 76022-6111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7010260 | AETNA (01) | TX |
82392S | BC/BS (01) | TX |
H37345 | (02) | TX |