Provider Demographics
NPI:1114912821
Name:BEHARA, RATNA (MD)
Entity Type:Individual
Prefix:
First Name:RATNA
Middle Name:
Last Name:BEHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VENKATARATNAM
Other - Middle Name:
Other - Last Name:BEHARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1243 W BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2532
Mailing Address - Country:US
Mailing Address - Phone:956-787-8417
Mailing Address - Fax:956-787-6781
Practice Address - Street 1:1243 W HWY 83
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2532
Practice Address - Country:US
Practice Address - Phone:956-787-8417
Practice Address - Fax:956-787-6781
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2016-05-13
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
TXF9094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111765701Medicaid
TXP00084054OtherMEDICARE RAILROAD
TX00GW70OtherBCBS
TXP00084054OtherMEDICARE RAILROAD
TX00GW70Medicare PIN