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General NPI Number Information
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NPI Number | 1487773859
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Entity Type | Organization
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Legal Business Name | NANDAN KUMAR PUVVADA
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 10/01/2008
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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 | 75801-8491
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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 | 75801-8491
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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 | SOLE PROPRIETOR
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Name | NANDAN K PUVVADA
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Credential | M.D.
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Telephone | 903-723-0033
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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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