Provider Demographics
NPI:1851797914
Name:BANJARA, HARI PRASAD
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:PRASAD
Last Name:BANJARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 19TH ST
Mailing Address - Street 2:BOX 162
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1203
Mailing Address - Country:US
Mailing Address - Phone:806-725-4130
Mailing Address - Fax:
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:BOX 162
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717599363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care