Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | K3630 | TX |
NPI | 1043296353 |
---|---|
Provider Name | Dr. Rajesh V Putcha |
First Address | Dallas, TX 75235-0269 |
Second Address | Mckinney, TX 75071-7889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 16/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045522202 | (05) | TX |
8F7160 | BCBS (01) | TX |
G95530 | (02) | TX |