Provider Demographics
NPI:1518903681
Name:GUNIGANTI, PRABHAKAR R (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAKAR
Middle Name:R
Last Name:GUNIGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MOUND STREET
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-560-1844
Mailing Address - Fax:936-715-9135
Practice Address - Street 1:1303 MOUND STREET
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-560-1844
Practice Address - Fax:936-564-5145
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG2712207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88G51OtherMEDICARE/BCBS ID
TX88G51OtherMEDICARE/BCBS ID