Provider Demographics
NPI:1043449465
Name:SHANMUGAM, NATRAJ AIYAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATRAJ
Middle Name:AIYAPPAN
Last Name:SHANMUGAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-696-5663
Mailing Address - Fax:979-694-1319
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-696-5663
Practice Address - Fax:979-694-1319
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP8538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP8538OtherMEDICAL LICENSE