Provider Demographics
NPI:1932382165
Name:P RAJU INDUKURI MD PA
Entity type:Organization
Organization Name:P RAJU INDUKURI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:DR
Authorized Official - First Name:P
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:INDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-222-9907
Mailing Address - Street 1:2707 AIRPORT FWY
Mailing Address - Street 2:#206
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-2389
Mailing Address - Country:US
Mailing Address - Phone:817-222-9907
Mailing Address - Fax:817-222-9909
Practice Address - Street 1:2707 AIRPORT FWY
Practice Address - Street 2:#206
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2389
Practice Address - Country:US
Practice Address - Phone:817-222-9907
Practice Address - Fax:817-222-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00371XMedicare PIN