Provider Demographics
NPI:1861789687
Name:GANDRA, RAGHA DIVYA (MD)
Entity type:Individual
Prefix:
First Name:RAGHA
Middle Name:DIVYA
Last Name:GANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N MARIENFELD ST STE 1090
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3337
Mailing Address - Country:US
Mailing Address - Phone:432-570-0238
Mailing Address - Fax:432-699-3815
Practice Address - Street 1:801 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-8212
Practice Address - Country:US
Practice Address - Phone:432-685-0450
Practice Address - Fax:432-685-0459
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040144207R00000X
TXP7915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine