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General NPI Number Information
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NPI Number | 1063653376
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Entity Type | Organization
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Legal Business Name | RAVI K. MOOTHA, M.D., P.A.
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 09/20/2009
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Provider Practice Location Address
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Address Line | 2821 E PRESIDENT GEORGE BUSH HWY SUITE 305
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City | RICHARDSON
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State | TX
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Zip | 75082-4266
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Country | US
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Telephone | 972-235-3248
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Fax | 972-235-3984
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Provider Business Mailing Address
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Address Line | 2821 E PRESIDENT GEORGE BUSH HWY SUITE 305
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City | RICHARDSON
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State | TX
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Zip | 75082-4266
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Country | US
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Telephone | 972-235-3248
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Fax | 972-235-3984
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAVI KANTH MOOTHA
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Credential | M.D.
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Telephone | 214-514-8480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | L7054
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License Number State | TX
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