Individual
DR. SRINIVASA RAO KOTHAPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 JIMMY JOHNSON BOULEVARD, SUITE 500, PORT ARTHUR, TX 77640
(409) 723-6600
(409) 723-6698
Mailing address
2501 JIMMY JOHNSON BOULEVARD, SUITE 500, PORT ARTHUR, TX 77640
(409) 723-6600
(409) 723-6698
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J1286
TX
207RI0011X
Interventional Cardiology Physician
J1286
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060042362
PALMETTO GBA
—
01
—
22015
GTPA
TX
Enumeration date
03/09/2006
Last updated
03/31/2020
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