Individual
PRASAD DEVABHAKTUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3560 DELAWARE ST STE 209, BEAUMONT, TX 77706-3059
(409) 899-3682
Mailing address
3560 DELAWARE ST STE 209, BEAUMONT, TX 77706-3059
(409) 899-3682
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036060837
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360608371
—
IL
05
—
200108170
—
IN
05
—
200462402
—
TX
Enumeration date
07/11/2006
Last updated
06/20/2012
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