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Organization
PEARL FAMILY PRACTICE PA
Active
Organization
PEARL FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJU KURUNTHOTTICAL D.O. (PRESIDENT/OWNER)
(512) 869-8500
Entity
Organization
Contact information
Practice address
950 W UNIVERSITY AVE, BUILDING 1, SUITE 104, GEORGETOWN, TX 78626-6505
(512) 869-8500
(512) 869-5052
Mailing address
950 W UNIVERSITY AVE, BUILDING 1, SUITE 104, GEORGETOWN, TX 78626-6505
(512) 869-8500
(512) 869-5052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K8276
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009RT
BCBS GROUP #
TX
05
—
198021101
—
TX
Enumeration date
08/25/2008
Last updated
07/07/2009
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