Individual
RAGHAVENDRA S PRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
445 E FM 1382 #3354, CEDAR HILL, TX 75104
(214) 325-1969
(972) 291-0019
Mailing address
445 E FM 1382 #3354, CEDAR HILL, TX 75104
(214) 325-1969
(972) 291-0019
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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