Provider Demographics
NPI:1700823945
Name:MISHRA, DEEPTI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 E WINDING WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:281-996-7788
Mailing Address - Fax:281-996-8276
Practice Address - Street 1:1650 E WINDING WAY
Practice Address - Street 2:SUITE B
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546
Practice Address - Country:US
Practice Address - Phone:281-996-7788
Practice Address - Fax:281-996-8276
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8K0812Medicare PIN
TXH26672Medicare UPIN