Provider Demographics
NPI:1487691572
Name:NIRMAL, KODAVAYOUR S (MD)
Entity type:Individual
Prefix:MR
First Name:KODAVAYOUR
Middle Name:S
Last Name:NIRMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MR
Other - First Name:KODUVAYOUR
Other - Middle Name:SETHURAMAN
Other - Last Name:NIRMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS MD
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-772-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047095207Q00000X
TXM6314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00047095OtherLICENSE