Individual
ANANT CHELVA PRABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 SAINT MARKS PL, SUITE 130, LA GRANGE, TX 78945-1250
(979) 242-5605
(979) 242-5619
Mailing address
2 SAINT MARKS PL, SUITE 130, LA GRANGE, TX 78945-1250
(979) 242-5605
(979) 242-5619
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J6669
TX
2086S0102X
Surgical Critical Care Physician
J6669
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043958001
—
TX
Enumeration date
06/09/2006
Last updated
02/03/2014
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