Individual
DR. LAXMAN R KALVAKUNTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
63 WATERFORD DR, NACOGDOCHES, TX 75965-8717
(936) 645-1044
(936) 205-1328
Mailing address
63 WATERFORD DR, NACOGDOCHES, TX 75965-8717
(936) 645-1044
(936) 205-1328
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
J2627
TX
207R00000X
Internal Medicine Physician
J2627
TX
208M00000X
Hospitalist Physician
Primary
J2627
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J23M
MEDICARE ID
TX
05
—
1303655301
—
TX
Enumeration date
06/28/2005
Last updated
03/01/2021
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