Provider Demographics
NPI:1023187614
Name:POTHURI, BHARAT (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:
Last Name:POTHURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 HUFFMEISTER RD STE 280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3430
Mailing Address - Country:US
Mailing Address - Phone:832-632-4070
Mailing Address - Fax:832-688-9496
Practice Address - Street 1:10425 HUFFMEISTER RD STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3430
Practice Address - Country:US
Practice Address - Phone:832-632-4070
Practice Address - Fax:832-688-9496
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8896207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167464001Medicaid
TX8W5340OtherBLUE CROSS BLUE SHIELD NO
TX8W5340OtherBLUE CROSS BLUE SHIELD NO
TX610827Medicare ID - Type Unspecified