Provider Demographics
NPI:1295969699
Name:THOKALA, RAMAKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:RAMAKRISHNA
Middle Name:
Last Name:THOKALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 W GOLF COURSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5110
Mailing Address - Country:US
Mailing Address - Phone:432-522-2304
Mailing Address - Fax:432-522-2307
Practice Address - Street 1:3302 W GOLF COURSE RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5110
Practice Address - Country:US
Practice Address - Phone:432-522-2304
Practice Address - Fax:432-522-2307
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015025783207R00000X
TXR6690207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295969699Medicaid
TX384437501Medicaid
TX1295969699Medicaid