Provider Demographics
NPI:1871537431
Name:RAO, GADAM M (MD)
Entity type:Individual
Prefix:
First Name:GADAM
Middle Name:M
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4289
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0289
Mailing Address - Country:US
Mailing Address - Phone:940-761-2229
Mailing Address - Fax:940-761-2220
Practice Address - Street 1:1718 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5053
Practice Address - Country:US
Practice Address - Phone:940-761-2229
Practice Address - Fax:940-761-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK1634208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048AROtherBLUE CROSS BLUE SHIELD
TX092131401Medicaid
TX092131402Medicaid
TX8AJ053OtherBCBS OF TX
TX200532013OtherPROFESSIONAL ASSOCIATION
TX092131402Medicaid