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General NPI Number Information
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NPI Number | 1720169311
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Entity Type | Organization
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Legal Business Name | ADOLESCENT & ADULT ALLERGY CENTER, P.A.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 2400 E 8TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4902
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Country | US
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Telephone | 432-332-5533
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Fax | 432-580-5533
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Provider Business Mailing Address
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Address Line | 2400 E 8TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4902
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Country | US
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Telephone | 432-332-5533
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Fax | 432-580-5533
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Authorized Official
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Title or Position | PHYSCIAN / OWNER
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Name | DR. P.K. RAGHU
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Credential | M.D.
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Telephone | 432-332-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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