Provider Demographics
NPI:1750667416
Name:RAGHU V DEVABHAKTUNI MDPA
Entity Type:Organization
Organization Name:RAGHU V DEVABHAKTUNI MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:V
Authorized Official - Last Name:DEVABHAKTUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-869-3227
Mailing Address - Street 1:13908 LAKESHORE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1492
Mailing Address - Country:US
Mailing Address - Phone:727-869-3227
Mailing Address - Fax:
Practice Address - Street 1:13908 LAKESHORE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1492
Practice Address - Country:US
Practice Address - Phone:727-869-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61245261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty