Provider Demographics
NPI:1457439861
Name:SINGH, PRAFULLA C (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAFULLA
Middle Name:C
Last Name:SINGH
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:PO BOX 12952
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0952
Mailing Address - Country:US
Mailing Address - Phone:210-527-1166
Mailing Address - Fax:210-527-1163
Practice Address - Street 1:1200 BROOKLYN AVE STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4817
Practice Address - Country:US
Practice Address - Phone:210-527-1166
Practice Address - Fax:210-527-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9353207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX435455AU1COtherMEDICARE
TX0027BROtherBLUE CROSS
TX0802886-01Medicaid
TXF96098Medicare UPIN