Individual
PRABHAKAR R GUNIGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1303 MOUND STREET, NACOGDOCHES, TX 75961
(936) 560-1844
(936) 564-5145
Mailing address
1303 MOUND STREET, NACOGDOCHES, TX 75961
(936) 560-1844
(936) 715-9135
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G2712
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88G51
MEDICARE/BCBS ID
TX
Enumeration date
06/20/2006
Last updated
04/01/2014
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