MEDICARE: NAGARAJA R SRINIVASAMURTHY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	F3625	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88Y336	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1265465686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGARAJA R SRINIVASAMURTHY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 1ST ST E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-5238
Country	:	US
Telephone Number	:	281-446-4139
Fax Number	:	281-446-4860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/12/2008

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