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General NPI Number Information
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NPI Number | 1114012283
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Entity Type | Organization
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Legal Business Name | SURESH PRASAD MD PA
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 601 E 2ND SUITE A
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City | ODESSA
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State | TX
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Zip | 79761
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Country | US
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Telephone | 432-332-3400
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Fax | 432-332-6500
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Provider Business Mailing Address
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Address Line | PO BOX 4147
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City | ODESSA
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State | TX
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Zip | 79760
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Country | US
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Telephone | 432-332-3400
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Fax | 432-332-6500
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SURESH PRASAD
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Credential | MD
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Telephone | 432-332-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K8430
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License Number State | TX
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