Basic Information
| Provider Information | |||||||||
| NPI: | 1265571145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAJGOPAL PAKANATI MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 132168 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773932168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E CROCKETT ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773274029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815931811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 01/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | PAKANATI | ||||||||
| AuthorizedOfficialFirstName: | RAJGOPAL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2815931811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0083HD | 01 | TX | BCBS | OTHER |