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Individual

KALYAN KUMAR RATH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1273 S PEACHTREE, JASPER, TX 75951
(409) 384-9200
(409) 384-9205
Mailing address
1273 S. PEACHTREE ST., JASPER, TX 75951
(409) 384-9200
(409) 384-9205

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K1016
TX
261QR1300X
Rural Health Clinic/Center
K1016
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
121389401
TX
Enumeration date
08/05/2006
Last updated
06/01/2011
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