Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | L5878 | TX |
NPI | 1336245133 |
---|---|
Provider Name | Sujit Prabhu |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 03/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140008274 | RR MEDICARE (01) | TX |
157703301 | (05) | TX |
8H3242 | BCBS (01) | TX |
H77884 | (02) |