Individual
RADHA PASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1206 W HENDERSON ST STE C, CLEBURNE, TX 76033-8772
(817) 877-5858
Mailing address
1000 W CANNON ST, FORT WORTH, TX 76104-3029
(817) 725-7900
(682) 207-1030
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
P4225
TX
207RN0300X
Nephrology Physician
Primary
P4225
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P4225
TEXAS MEDICAL LICENSE
TX
01
—
R0196810
DPS
TX
Enumeration date
06/13/2008
Last updated
03/07/2023
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