Provider Demographics
NPI:1104818095
Name:LAL, SUNDEEP S (MD)
Entity type:Individual
Prefix:DR
First Name:SUNDEEP
Middle Name:S
Last Name:LAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2705 HOSPITAL DR
Mailing Address - Street 2:STE 206
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-582-7989
Mailing Address - Fax:361-582-7990
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:STE 206
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-582-7989
Practice Address - Fax:361-582-7990
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3708207X00000X
TXN9382208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150135001Medicaid
TXTXB144344Medicare PIN
ARH89831Medicare UPIN
AR5M603Medicare ID - Type Unspecified