Provider Demographics
NPI:1962698860
Name:RAO, UDIPI P (MD)
Entity type:Individual
Prefix:
First Name:UDIPI
Middle Name:P
Last Name:RAO
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 1:500 ADAMS AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4656
Mailing Address - Country:US
Mailing Address - Phone:432-334-0433
Mailing Address - Fax:432-334-0414
Practice Address - Street 1:500 ADAMS AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4656
Practice Address - Country:US
Practice Address - Phone:432-334-0433
Practice Address - Fax:432-334-0414
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF8631207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1103947 02Medicaid
TX8AJ292OtherBLUE CROSS BLUESHIELD
TXC20860Medicare UPIN
TX1103947 02Medicaid