Provider Demographics
NPI:1487881124
Name:MISHRA, RAHUL (DO)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:MISHRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 LEGACY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6748
Mailing Address - Country:US
Mailing Address - Phone:630-207-0999
Mailing Address - Fax:469-269-1064
Practice Address - Street 1:4040 LEGACY DR STE 204
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6748
Practice Address - Country:US
Practice Address - Phone:469-269-1060
Practice Address - Fax:469-269-1064
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034008207L00000X
TXP9653207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology