Jayaprabhu, Sudheer M
Jayaprabhu, Sudheer M is an individual health care provider with primary practice located at 1002 Texas Blvd Suite 200, Texarkana TX 75501-5107. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jayaprabhu, Sudheer M can be contacted via phone (903) 792-4808.Contact Information
Primary practice address
1002 Texas Blvd Suite 200
Texarkana TX 75501-5107
Phone: (903) 792-4808
Fax: (903) 792-2681
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | L2351 | Texas |
Profile Details
| NPI number | 1639176555 |
|---|---|
| LBN Legal business name | Jayaprabhu, Sudheer M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Oct 29th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639176555 | NPPES |
| Texas | MEDICAID | 145699804 |
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