Provider Demographics
NPI:1124172010
Name:NAMBURU, VENKAT ESWARA-RAO (MD)
Entity type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:ESWARA-RAO
Last Name:NAMBURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VENKATESWARA
Other - Middle Name:RAO
Other - Last Name:NAMBURU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7633 BELLAIRE DR S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4311
Mailing Address - Country:US
Mailing Address - Phone:817-386-5767
Mailing Address - Fax:817-386-5857
Practice Address - Street 1:7633 BELLAIRE DR S
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4311
Practice Address - Country:US
Practice Address - Phone:817-386-5767
Practice Address - Fax:817-386-5857
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3766207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151742702Medicaid
TX151742702Medicaid
F47456Medicare UPIN