Provider Demographics
NPI:1487705265
Name:VIJAYVARGIYA, PRABHU D (MD)
Entity type:Individual
Prefix:DR
First Name:PRABHU
Middle Name:D
Last Name:VIJAYVARGIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRABHU
Other - Middle Name:D
Other - Last Name:VIJAYVARGIYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3885
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3885
Mailing Address - Country:US
Mailing Address - Phone:814-335-0580
Mailing Address - Fax:
Practice Address - Street 1:615 E OKLAHOMA AVE STE 208
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5952
Practice Address - Country:US
Practice Address - Phone:814-335-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26689207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine