Individual
RAJA PRAKASHAM PASPULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9202 ELAM RD, SOUTHEAST DALLAS HEALTH CENTER, DALLAS, TX 75217-4151
(214) 266-1706
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
217823
MA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
055701A
IN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
224658
NY
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
M6333
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184979601
—
TX
05
—
184979602
—
TX
01
—
8W8857
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/24/2006
Last updated
01/21/2013
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