=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972968584
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOCUS INTERNAL MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2015
-----------------------------------------------------
Last Update Date | 12/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 N PARK BLVD SUITE 100
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-6987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-651-5725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 N PARK BLVD SUITE 100
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-6987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-651-5725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. PRASUNA DUBAGUNTA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 682-651-5725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | N1617
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------