Individual
DR. RAVI V PACHIGOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2016 FORT WORTH HWY, WEATHERFORD, TX 76086-4706
(817) 596-8637
(855) 217-1123
Mailing address
2016 FORT WORTH HWY, WEATHERFORD, TX 76086-4706
(817) 596-8637
(855) 217-1123
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
K4763
TX
207YX0602X
Otolaryngic Allergy Physician
K4763
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z738
MEDICARE GROUP PIN
TX
01
—
198437901
MEDICAID GROUP
TX
05
—
198438701
—
TX
01
—
K4763
TX LICENSE
TX
Enumeration date
09/23/2005
Last updated
04/28/2022
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