Individual
AJAY PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11937 HWY 271, TYLER, TX 75708-3154
(903) 877-7253
Mailing address
11937 HWY 271, TYLER, TX 75708-3154
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
BP10090383
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2024
Last updated
06/05/2024
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