NPIMap

Organization Active NPI

Deer Park Physician Group PLLC

  • Emergency Medicine Physician
  • Deer Park, TX
National Provider Identifier
1235795535
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
DEER PARK PHYSICIAN GROUP PLLC
Practice address
1101 East Blvd
Deer Park, TX 77536-1909
Phone
(346) 954-6007
NPI assigned
May 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Radheshyam Miryala, MD
Title
Owner
Phone
(346) 954-6007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1101 East Blvd
Deer Park, TX 77536-1909

Mailing address

PO Box 520
Spring, TX 77383-0520

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1235795535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773830520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 EAST BLVD",
            "city": "DEER PARK",
            "state": "TX",
            "postal_code": "775361909",
            "telephone_number": "346-954-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER PARK PHYSICIAN GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "MIRYALA",
        "authorized_official_first_name": "RADHESHYAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "346-954-6007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.