Provider Demographics
NPI:1073973327
Name:RAHUL D PURI MD PA
Entity Type:Organization
Organization Name:RAHUL D PURI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:432-556-1824
Mailing Address - Street 1:1514 NEHEMIAH DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-2304
Mailing Address - Country:US
Mailing Address - Phone:432-556-1824
Mailing Address - Fax:
Practice Address - Street 1:720 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3617
Practice Address - Country:US
Practice Address - Phone:432-556-1824
Practice Address - Fax:713-464-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty