Provider Demographics
NPI:1700891579
Name:VANGURU, RAGHUVEER (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHUVEER
Middle Name:
Last Name:VANGURU
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 1:3315 COLORADO BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6885
Mailing Address - Country:US
Mailing Address - Phone:940-320-1708
Mailing Address - Fax:940-320-1708
Practice Address - Street 1:10700 VICTORIA ASH DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6392
Practice Address - Country:US
Practice Address - Phone:817-380-4168
Practice Address - Fax:817-562-5560
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3262207RN0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307464301Medicaid
TXTXB164809Medicare PIN
CAZZZ93296ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY NMC
CAA93564Medicare UPIN