Provider Demographics
NPI:1881658474
Name:NAIR, PRASANNA K (MD)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:K
Last Name:NAIR
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 1:12221 MOPAC EXPRESSWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-901-4007
Mailing Address - Fax:512-901-3907
Practice Address - Street 1:12221 MOPAC EXPRESSWAY NORTH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2483
Practice Address - Country:US
Practice Address - Phone:512-901-4007
Practice Address - Fax:512-901-3907
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5317207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110633805Medicaid
TX110633805Medicaid
TX8G0796Medicare PIN
TXC19765Medicare UPIN