Healthcare Provider Details

I. General information

NPI: 1700891579
Provider Name (Legal Business Name): RAGHUVEER VANGURU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 VICTORIA ASH DR
FORT WORTH TX
76244-6392
US

IV. Provider business mailing address

1600 WATERS RIDGE DR STE A
LEWISVILLE TX
75057-6039
US

V. Phone/Fax

Practice location:
  • Phone: 817-380-4168
  • Fax: 817-562-5560
Mailing address:
  • Phone: 940-320-1708
  • Fax: 940-320-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberP3262
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: