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General NPI Number Information
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NPI Number | 1487881124
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Entity Type | Individual
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Provider Name | RAHUL MISHRA D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2009
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 4040 LEGACY DR STE 204
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City | FRISCO
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State | TX
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Zip | 75034-6748
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Country | US
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Telephone | 469-269-1060
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Fax | 469-269-1064
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Provider Business Mailing Address
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Address Line | 4040 LEGACY DR STE 204
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City | FRISCO
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State | TX
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Zip | 75034-6748
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Country | US
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Telephone | 630-207-0999
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Fax | 469-269-1064
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | BP10034008
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | P9653
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License Number State | TX
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