Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | R2337 | TX |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | R2337 | TX |
Y | 207RI0011X | Interventional Cardiology | R2337 | TX |
NPI | 1184854721 |
---|---|
Provider Name | Dr. Subramanya Vara Prasad Gajaraju Venkata |
First Address | The Woodlands, TX 77384-8040 |
Second Address | Lufkin, TX 75904-3173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 08/02/2022 |