Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | K0874 | TX |
NPI | 1972503092 |
---|---|
Provider Name | Suresh Koneru |
First Address | San Antonio, TX 78209-2060 |
Second Address | San Antonio, TX 78209-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029455501 | (05) | TX |
G33324 | (02) | TX |