Provider Demographics
NPI:1306259742
Name:RAHUL PATRI MD PLLC
Entity type:Organization
Organization Name:RAHUL PATRI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-838-2626
Mailing Address - Street 1:3345 PLAZA 10 DR
Mailing Address - Street 2:STE E
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2554
Mailing Address - Country:US
Mailing Address - Phone:409-838-2626
Mailing Address - Fax:
Practice Address - Street 1:3345 PLAZA 10 DR
Practice Address - Street 2:STE E
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2554
Practice Address - Country:US
Practice Address - Phone:409-838-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360163Medicare PIN