Individual
DR. PRASANTH BOYAREDDIGARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 MEDICAL CENTER BLVD, CONROE, TX 77304-2808
(936) 539-1111
Mailing address
6873 STAFFORDSHIRE ST, HOUSTON, TX 77030-4107
(713) 795-0939
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M1031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8P5097
BCBSTX PIN
TX
01
—
8S0397
BLUE SHIELD
TX
01
—
P00234966
RR/MEDICARE
TX
Enumeration date
04/03/2006
Last updated
12/07/2007
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