MEDICARE: VENKAT NAMBURU MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	L3766	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407843626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENKAT NAMBURU MD PA

Provider Business Mailing Address
First Line	:	7633 BELLAIRE DR S
Second Line	:	SUITE 105
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4311
Country	:	US
Telephone Number	:	817-386-5767
Fax Number	:	817-386-5857

Provider Business Practice Location Address
First Line	:	7633 BELLAIRE DR S
Second Line	:	SUITE 105
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4311
Country	:	US
Telephone Number	:	817-386-5767
Fax Number	:	817-386-5857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VENKAT ESWARA-RAO NAMBURU
Credential	:	M.D.
Telephone Number	:	817-386-5767

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	10/06/2017

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