Individual
NANDAN K PUVVADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4002 S LOOP 256, SUITE L, PALESTINE, TX 75801-8403
(903) 723-0033
(903) 723-0036
Mailing address
4002 S LOOP 256, SUITE L, PALESTINE, TX 75801-8403
(903) 723-0033
(903) 723-0036
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M5002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351870765
TAX ID
—
Enumeration date
10/23/2006
Last updated
09/26/2012
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