Provider Demographics
NPI:1013913466
Name:SUKHAVASI, UMA (MD)
Entity Type:Individual
Prefix:
First Name:UMA
Middle Name:
Last Name:SUKHAVASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2007
Mailing Address - Country:US
Mailing Address - Phone:409-721-5155
Mailing Address - Fax:409-722-6530
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:STE 301
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2007
Practice Address - Country:US
Practice Address - Phone:409-721-5155
Practice Address - Fax:409-722-6530
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXK6348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG72055Medicare UPIN
TX00619DMedicare ID - Type Unspecified