Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | Q7598 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | 01053263 | IN |
NPI | 1184733156 |
---|---|
Provider Name | Shekhar Siddappa Raj |
First Address | Dallas, TX 75266-0645 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022990723A | (05) | GA |
036103896 | (05) | IL |
1021332 | (05) | VT |
1810967 | (05) | LA |
200338070 | (05) | IN |
7100316660 | (05) | KY |
I48968 | (02) | |
P01824553 | RR MEDICARE (01) | IN |