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Contact Information

RAVI KONIDALA, MD
1050 E LOOP 304
SUITE 200, ETMC RURAL HEALTH CLINIC
CROCKETT, TX75835-1814
 Phone: 936-544-5132
 Fax: 936-544-8029
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for RAVI KONIDALA · (Male)

NPI # 1124013552
Status Active
Credentials MD
Entity Individual
Enumeration date 09/12/2005
Last updated 06/02/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • TX License # M6981
  • PA Medicaid 1010424560001
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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