Provider Demographics
NPI:1568624682
Name:SOMAYAZULA, RAVI K (DO)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:K
Last Name:SOMAYAZULA
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 1:9230 KATY FWY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7469
Mailing Address - Country:US
Mailing Address - Phone:281-242-1061
Mailing Address - Fax:832-939-8420
Practice Address - Street 1:9230 KATY FWY
Practice Address - Street 2:SUITE 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7469
Practice Address - Country:US
Practice Address - Phone:281-242-1061
Practice Address - Fax:832-939-8420
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218605208600000X
TXP1023208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023XJOtherBLUE CROSS BLUE SHIELD
TX0023XJOtherBLUE CROSS BLUE SHIELD