Provider Demographics
NPI:1386621977
Name:MEDI, RAVI (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:MEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 JOHN BEN SHEPPERD PKWY STE C129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1953
Mailing Address - Country:US
Mailing Address - Phone:432-333-1333
Mailing Address - Fax:432-333-1335
Practice Address - Street 1:2626 JOHN BEN SHEPPERD PKWY STE C129
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1953
Practice Address - Country:US
Practice Address - Phone:432-333-1333
Practice Address - Fax:432-333-1335
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK01302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036338402Medicaid
8A1958Medicare PIN
TXC41492Medicare UPIN