Provider Demographics
NPI:1063595890
Name:PUVVADA, LAKSHMI MALATHY (MD)
Entity type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:MALATHY
Last Name:PUVVADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4002 S LOOP 256
Mailing Address - Street 2:SUITE L
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8491
Mailing Address - Country:US
Mailing Address - Phone:903-723-0033
Mailing Address - Fax:903-723-0036
Practice Address - Street 1:4002 S LOOP 256
Practice Address - Street 2:SUITE L
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8491
Practice Address - Country:US
Practice Address - Phone:903-723-0033
Practice Address - Fax:903-723-0036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5001207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF98581Medicare UPIN
TX00X404Medicare PIN