Individual
DR. PUTHALATH KOROTH RAGHUPRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2400 E 8TH ST, ODESSA, TX 79761-4902
(432) 332-5533
(432) 580-5533
Mailing address
2400 E 8TH ST, ODESSA, TX 79761-4902
(432) 332-5533
(432) 580-5533
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
F8987
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0357949-01
—
TX
Enumeration date
04/26/2006
Last updated
07/23/2008
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