Provider Demographics
NPI:1669406195
Name:BHASKARA M PONNURU MD, PA
Entity type:Organization
Organization Name:BHASKARA M PONNURU MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHASKARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONNURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-486-9649
Mailing Address - Street 1:15518 CONIFER BAY COURT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3186
Mailing Address - Country:US
Mailing Address - Phone:281-486-9649
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:CLEAR LAKE REGIONAL MEDICAL CENTER
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-332-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86290NMedicare ID - Type Unspecified
A14112Medicare UPIN