=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811191471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARASWATHI DOPATHI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 06/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 S 1ST ST
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76504-7451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-743-1625
-----------------------------------------------------
Fax | 254-743-0135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2663 SALORN WAY
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-672-9743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | N0738
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------