Individual
PREMA MANJUNATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 927-3638
(817) 923-8769
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 927-3638
(817) 923-8769
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
H3699
TX
2084P0800X
Psychiatry Physician
H3699
TX
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
H3699
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135013410
—
TX
01
—
83702S
BCBS
TX
01
—
P00340949
RAILROAD MEDICARE
TX
Enumeration date
05/23/2006
Last updated
08/09/2016
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