Provider Demographics
NPI:1871586768
Name:PUAR, RAVINDER K (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:K
Last Name:PUAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:K
Other - Last Name:PUAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2761 E TRINITY MILLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-3506
Mailing Address - Country:US
Mailing Address - Phone:972-478-8800
Mailing Address - Fax:972-478-8813
Practice Address - Street 1:2761 E TRINITY MILLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3506
Practice Address - Country:US
Practice Address - Phone:972-478-8800
Practice Address - Fax:972-478-8813
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1825207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009LBOtherBLUE SHIELD
TX121518807Medicaid
TX121518806Medicaid
TX121518806Medicaid
TX121518807Medicaid