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General NPI Number Information
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NPI Number | 1124172010
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Entity Type | Individual
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Provider Name | VENKAT ESWARA-RAO NAMBURU M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 7633 BELLAIRE DR S SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76132-4311
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Country | US
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Telephone | 817-386-5767
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Fax | 817-386-5857
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Provider Business Mailing Address
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Address Line | 7633 BELLAIRE DR S SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76132-4311
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Country | US
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Telephone | 817-386-5767
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Fax | 817-386-5857
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | L3766
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License Number State | TX
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