Individual
BALAKRISHNA R PRABHAKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1259 FM 1463 RD STE 400, KATY, TX 77494-5480
(713) 429-4550
(832) 397-6426
Mailing address
8806 N NAVARRO ST STE 600, VICTORIA, TX 77904-1564
(361) 485-2695
(361) 485-0635
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19872
WV
207R00000X
Internal Medicine Physician
Primary
N 1075
TX
208000000X
Pediatrics Physician
19872
WV
208000000X
Pediatrics Physician
N 1075
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720356
MS BCBS
WV
05
—
6000462000
—
WV
01
—
N1075
MEDICAL LICENSE
TX
Enumeration date
03/14/2006
Last updated
05/01/2024
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