Basic Information
| Provider Information | |||||||||
| NPI: | 1669406195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHASKARA M PONNURU MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15518 CONIFER BAY COURT | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770593186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814869649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | CLEAR LAKE REGIONAL MEDICAL CENTER | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813322511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PONNURU | ||||||||
| AuthorizedOfficialFirstName: | BHASKARA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2814869649 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | F8619 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.