Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0116018184 | VA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | N8039 | TX |
NPI | 1235340290 |
---|---|
Provider Name | Durga Prasad Mekala |
First Address | Arlington, TX 76015-2910 |
Second Address | Arlington, TX 76015-2910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 10/03/2014 |