Provider Demographics
NPI:1386723955
Name:PAKANATI, RAJGOPAL R (MD)
Entity type:Individual
Prefix:
First Name:RAJGOPAL
Middle Name:R
Last Name:PAKANATI
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 1:74 N BERRYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4816
Mailing Address - Country:US
Mailing Address - Phone:832-654-5533
Mailing Address - Fax:
Practice Address - Street 1:300 E CROCKETT ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4029
Practice Address - Country:US
Practice Address - Phone:660-826-5960
Practice Address - Fax:660-826-4852
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149896601Medicaid
TX149896601Medicaid