Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | L7126 | TX |
NPI | 1093788481 |
---|---|
Provider Name | Venkata Nakta Raju |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158391601 | (05) | TX |
158391602 | (05) | TX |
158391603 | (05) | TX |
158391604 | (05) | TX |
158391605 | (05) | TX |
158391606 | (05) | TX |
158391607 | (05) | TX |