Provider Demographics
NPI:1275071136
Name:COORAY, NAWALAGE RAVI (MD)
Entity Type:Individual
Prefix:
First Name:NAWALAGE RAVI
Middle Name:
Last Name:COORAY
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 1:8121 RIMINI TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-8064
Mailing Address - Country:US
Mailing Address - Phone:512-632-0843
Mailing Address - Fax:
Practice Address - Street 1:1201 HILL RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-9533
Practice Address - Country:US
Practice Address - Phone:512-237-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine