Individual
RAGHAVENDRA S PRASAD
Active
Individual
RAGHAVENDRA S PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
J6213
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132640710
—
TX
05
—
148776102
—
TX
05
—
148776103
—
TX
01
—
8F7018
INDIVIDUAL PTAN/ DALLAS COUNTY
TX
01
—
8F7027
INDIVIDUAL PTAN #/ ELLIS & COLLINS COUNTY
TX
01
—
8F7028
INDIVIDUAL PTAN #/ TARRANT COUNTY
TX
Enumeration date
07/26/2006
Last updated
05/19/2008
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