Provider Demographics
NPI:1013913623
Name:KALVAKUNTLA, LAXMAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:LAXMAN
Middle Name:R
Last Name:KALVAKUNTLA
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 1:63 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-8717
Mailing Address - Country:US
Mailing Address - Phone:936-645-1044
Mailing Address - Fax:936-205-1328
Practice Address - Street 1:63 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-8717
Practice Address - Country:US
Practice Address - Phone:936-645-1044
Practice Address - Fax:936-205-1328
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2627207QA0505X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J23MOtherMEDICARE ID
TX1303655301Medicaid
TXF35966Medicare UPIN