Provider Demographics
NPI:1255595435
Name:EAPEN, PRAKASH SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:SAMUEL
Last Name:EAPEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7002
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-326-1682
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2021-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI16252207R00000X
MO2011022927207R00000X
TXP0722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2855033-01Medicaid