Provider Demographics
NPI:1992707848
Name:SUBNANI, RAJ (MD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:SUBNANI
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 1:211 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4706
Mailing Address - Country:US
Mailing Address - Phone:361-668-0055
Mailing Address - Fax:361-668-0057
Practice Address - Street 1:211 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4706
Practice Address - Country:US
Practice Address - Phone:361-668-0055
Practice Address - Fax:361-668-0057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDO648Medicare UPIN
TX00H49VMedicare ID - Type Unspecified