Provider Demographics
NPI:1376771915
Name:DAGGUBATI, VINOOP (DO)
Entity Type:Individual
Prefix:
First Name:VINOOP
Middle Name:
Last Name:DAGGUBATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1301 W 38TH ST STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1011
Practice Address - Country:US
Practice Address - Phone:512-324-1684
Practice Address - Fax:512-419-9016
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253656207R00000X
TXN3595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204574202Medicaid
TX204574201Medicaid
TX204574204Medicaid
TX204574203Medicaid
TX8L17436Medicare PIN
TX8L17435Medicare PIN
TXP00790374Medicare PIN
TX204574204Medicaid
TXP01154770Medicare PIN
TXTXB155072Medicare PIN