Provider Demographics
NPI:1932131505
Name:RAKLA, FAKHRUDDIN A (MD)
Entity Type:Individual
Prefix:
First Name:FAKHRUDDIN
Middle Name:A
Last Name:RAKLA
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 1:9950 MEMORIAL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4282
Mailing Address - Country:US
Mailing Address - Phone:281-446-6803
Mailing Address - Fax:281-446-0449
Practice Address - Street 1:9950 MEMORIAL
Practice Address - Street 2:SUITE 102
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4282
Practice Address - Country:US
Practice Address - Phone:281-446-6803
Practice Address - Fax:281-446-0449
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2750207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102514001Medicaid
TX81Y871Medicare ID - Type Unspecified
TX102514001Medicaid