Provider Demographics
NPI:1386732527
Name:THARAKAN, DAVID K (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:THARAKAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:K
Other - Last Name:THARAKAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2838 N LOOP 1604 E
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1712
Mailing Address - Country:US
Mailing Address - Phone:210-495-2117
Mailing Address - Fax:888-893-4363
Practice Address - Street 1:2838 N LOOP 1604 E
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1711
Practice Address - Country:US
Practice Address - Phone:210-495-2117
Practice Address - Fax:888-893-4363
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH25305Medicare UPIN
TXTXB149884Medicare PIN