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General NPI Number Information
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NPI Number | 1992952634
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Entity Type | Organization
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Legal Business Name | PEARL FAMILY PRACTICE PA
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 950 W UNIVERSITY AVE BUILDING 1, SUITE 104
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City | GEORGETOWN
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State | TX
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Zip | 78626-6505
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Country | US
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Telephone | 512-869-8500
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Fax | 512-869-5052
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Provider Business Mailing Address
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Address Line | 950 W UNIVERSITY AVE BUILDING 1, SUITE 104
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City | GEORGETOWN
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State | TX
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Zip | 78626-6505
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Country | US
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Telephone | 512-869-8500
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Fax | 512-869-5052
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | RAJU KURUNTHOTTICAL
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Credential | D.O.
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Telephone | 512-869-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K8276
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License Number State | TX
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