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General NPI Number Information
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NPI Number | 1083797823
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Entity Type | Individual
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Provider Name | NANDAN K PUVVADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 4002 S LOOP 256 SUITE L
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City | PALESTINE
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State | TX
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Zip | 75801-8403
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Country | US
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Telephone | 903-723-0033
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Fax | 903-723-0036
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Provider Business Mailing Address
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Address Line | 4002 S LOOP 256 SUITE L
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City | PALESTINE
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State | TX
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Zip | 75801-8403
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Country | US
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Telephone | 903-723-0033
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Fax | 903-723-0036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M5002
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License Number State | TX
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