Provider Demographics
NPI:1720125412
Name:RAGUTHU, SURYA PRAKASH (MD,)
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:PRAKASH
Last Name:RAGUTHU
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:PO BOX 5386
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5386
Mailing Address - Country:US
Mailing Address - Phone:956-546-7530
Mailing Address - Fax:956-546-7531
Practice Address - Street 1:315 JOSE MARTI BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-2868
Practice Address - Country:US
Practice Address - Phone:956-546-7530
Practice Address - Fax:956-546-7531
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9857208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL9857OtherTX LICENSE
TX8F0062Medicare ID - Type Unspecified