Provider Demographics
NPI:1699758664
Name:RAJU, PALIVELA P (MD)
Entity type:Individual
Prefix:DR
First Name:PALIVELA
Middle Name:P
Last Name:RAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 HOSPITAL CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4771
Mailing Address - Country:US
Mailing Address - Phone:979-241-6100
Mailing Address - Fax:979-241-6105
Practice Address - Street 1:600 HOSPITAL CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4771
Practice Address - Country:US
Practice Address - Phone:979-241-6100
Practice Address - Fax:979-241-6105
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG1166207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120471105Medicaid
TX338970YP90Medicare UPIN