Individual
RAJA V THOTAKURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1672
(260) 266-5230
Mailing address
1115 SE 164TH AVE, DEPT. 358, VANCOUVER, WA 98683-9324
(360) 729-1462
(360) 729-3104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60648172
WA
207RG0100X
Gastroenterology Physician
Primary
01083873A
IN
207RG0100X
Gastroenterology Physician
70108
WI
207RG0100X
Gastroenterology Physician
MD60648172
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2059422
—
WA
Enumeration date
07/28/2009
Last updated
10/07/2022
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