Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | J6617 | TX |
NPI | 1003836271 |
---|---|
Provider Name | Jayaprakash Narayana |
First Address | Greenville, TX 75401-5644 |
Second Address | Kaufman, TX 75142-1950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 12/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035133001 | (05) | TX |
035133002 | (05) | TX |
035133003 | (05) | TX |
035133004 | (05) | TX |
035133005 | (05) | TX |
F90851 | (02) | TX |