Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | M4701 | TX |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 058678 | GA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | M4701 | TX |
NPI | 1730265612 |
---|---|
Provider Name | Dr. Raghu Sudarshan Athre |
First Address | Houston, TX 77056-4390 |
Second Address | Houston, TX 77056-4390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 02/09/2020 |