Provider Demographics
NPI:1407909617
Name:BACKLAS, PURNIMA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:L
Last Name:BACKLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 LION LAKE DR S
Mailing Address - Street 2:
Mailing Address - City:PROGRESO LAKES
Mailing Address - State:TX
Mailing Address - Zip Code:78596-8387
Mailing Address - Country:US
Mailing Address - Phone:956-581-0303
Mailing Address - Fax:
Practice Address - Street 1:735 LION LAKE DR S
Practice Address - Street 2:
Practice Address - City:PROGRESO LAKES
Practice Address - State:TX
Practice Address - Zip Code:78596-8387
Practice Address - Country:US
Practice Address - Phone:956-581-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH73822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology