Provider Demographics
NPI:1720169311
Name:ADOLESCENT & ADULT ALLERGY CENTER, P.A.
Entity Type:Organization
Organization Name:ADOLESCENT & ADULT ALLERGY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:P.K.
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-332-5533
Mailing Address - Street 1:2400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4902
Mailing Address - Country:US
Mailing Address - Phone:432-332-5533
Mailing Address - Fax:432-580-5533
Practice Address - Street 1:2400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4902
Practice Address - Country:US
Practice Address - Phone:432-332-5533
Practice Address - Fax:432-580-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00401XMedicare PIN