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General NPI Number Information
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NPI Number | 1750667416
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Entity Type | Organization
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Legal Business Name | RAGHU V DEVABHAKTUNI MDPA
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 13908 LAKESHORE BLVD SUITE 210
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City | HUDSON
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State | FL
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Zip | 34667-1492
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Country | US
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Telephone | 727-869-3227
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Fax |
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Provider Business Mailing Address
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Address Line | 13908 LAKESHORE BLVD SUITE 210
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City | HUDSON
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State | FL
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Zip | 34667-1492
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Country | US
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Telephone | 727-869-3227
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. RAGHU V DEVABHAKTUNI
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Credential | MD
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Telephone | 727-869-3227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME 61245
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License Number State | FL
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