Individual
VIJAYA R POKALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.C.
Contact information
Practice address
1023 N MOUND ST, SUITE K, NACOGDOCHES, TX 75961-4491
(936) 564-2099
(936) 564-2083
Mailing address
1023 N MOUND ST, SUITE K, NACOGDOCHES, TX 75961-4491
(936) 564-2099
(936) 564-2083
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
H6917
TX
207RI0011X
Interventional Cardiology Physician
Primary
H6917
TX
207UN0901X
Nuclear Cardiology Physician
L05982
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179845601
—
TX
01
—
C0073073
CONTROLLED SUBSTANCE REGI
TX
01
—
H6917
PHYSICIAN LICENSE/PERMIT
TX
01
—
L05982
RADIOACTIVE MATERIAL LISC
TX
Enumeration date
08/11/2006
Last updated
03/07/2023
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