Provider Demographics
NPI:1124238191
Name:GOVINDU, RUKMA R (MD)
Entity type:Individual
Prefix:
First Name:RUKMA
Middle Name:R
Last Name:GOVINDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 1.150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-6714
Mailing Address - Fax:713-566-5025
Practice Address - Street 1:5656 KELLEY STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026
Practice Address - Country:US
Practice Address - Phone:713-566-4550
Practice Address - Fax:713-566-5025
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALL2762207Q00000X
WIWI 52231-20207R00000X
TXN5693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CH473OtherBCBS OF TEXAS
TXTXB101633OtherTX MEDICARE PTAN TXB101633