Provider Demographics
NPI:1891920997
Name:BOINPALLY, RAHUL (MD)
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:BOINPALLY
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 1:700 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-5626
Mailing Address - Country:US
Mailing Address - Phone:432-336-8110
Mailing Address - Fax:833-415-1031
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-5626
Practice Address - Country:US
Practice Address - Phone:432-336-8110
Practice Address - Fax:833-415-1031
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313120301Medicaid
TX1962663740Medicaid
TX1891920997Medicaid
TXP2832OtherTX LICENSE NO