Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101249410 | VA |
N | 111NI0900X | Internist | 0101249410 | VA |
N | 207R00000X | Internist | N3969 | TX |
N | 111NI0900X | Internist | N3969 | TX |
Y | 207RN0300X | Nephrologist | N3969 | TX |
NPI | 1003003609 |
---|---|
Provider Name | Uma B.r.k Pakkivenkata |
First Address | Dallas, TX 75231-0929 |
Second Address | Dallas, TX 75231-0929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 08/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3127078 | (05) | TX |