Provider Demographics
NPI:1053382754
Name:HEGDE, PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:
Last Name:HEGDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 SOUTH FWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7029
Mailing Address - Country:US
Mailing Address - Phone:817-293-4800
Mailing Address - Fax:817-293-4808
Practice Address - Street 1:11803 SOUTH FWY STE 201
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7029
Practice Address - Country:US
Practice Address - Phone:817-293-4800
Practice Address - Fax:817-293-4808
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146401001Medicaid
TX153488506Medicaid
TX8P2640OtherTEXAS BLUE CROSS
AR5M088OtherBLUE CROSS BLUE SHIELD
TXP00338137OtherRAILROAD MEDICARE
AR5M088OtherBLUE CROSS BLUE SHIELD