Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | M0534 | TX |
N | 208600000X | Surgeon | M0534 | TX |
Y | 2086S0120X | Pediatric Surgery | M0534 | TX |
NPI | 1003852930 |
---|---|
Provider Name | Dr. Ravi Radhakrishnan |
First Address | Galveston, TX 77555-0353 |
Second Address | Galveston, TX 77555-0353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 30/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8U9390 | BCBS (01) | TX |
I41600 | (02) | TX |
P00452855 | RAILROAD MEDICARE (01) | TX |