Provider Demographics
NPI:1144468984
Name:DAGGUBATI, SUBBA RAO (MD)
Entity type:Individual
Prefix:
First Name:SUBBA RAO
Middle Name:
Last Name:DAGGUBATI
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 1:10101 WESTRIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5922
Mailing Address - Country:US
Mailing Address - Phone:972-645-9400
Mailing Address - Fax:352-304-5993
Practice Address - Street 1:10101 WESTRIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5922
Practice Address - Country:US
Practice Address - Phone:972-645-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106066207Q00000X
IL125-052-719207Q00000X
TXR1730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1490NOtherBCBS
FL1490NOtherBCBS