Provider Demographics
NPI:1629084504
Name:RAO, VIVEK U (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:U
Last Name:RAO
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 1:500 ADAMS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4656
Mailing Address - Country:US
Mailing Address - Phone:432-333-3300
Mailing Address - Fax:
Practice Address - Street 1:500 ADAMS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4656
Practice Address - Country:US
Practice Address - Phone:432-333-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7855207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005PAOtherBLUECROSS BLUESHIELD OF TEXAS
TX152952100OtherFIRSTCARE
TX0005PAOtherBLUECROSS BLUESHIELD OF TEXAS