Individual
DR. PRAMODH KUMAR WADERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 CITYWEST BLVD STE 300, HOUSTON, TX 77042-2549
(972) 233-1999
Mailing address
PO BOX 840853, DALLAS, TX 75284-6404
(972) 715-5000
(281) 265-0774
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036073410
IL
207L00000X
Anesthesiology Physician
Primary
G1575
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
G1575
TX
208VP0014X
Interventional Pain Medicine Physician
G1575
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136242809
—
TX
05
—
136242810
—
TX
05
—
136242811
—
TX
01
—
214881
MEDICARE GROUP PTAN
IL
01
—
89807B
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/16/2005
Last updated
07/31/2020
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