Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD451728 | PA |
Y | 207L00000X | Anesthesiologist | Q7646 | TX |
NPI | 1013220631 |
---|---|
Provider Name | Abhishek Bhari Jayadevappa |
First Address | Odessa, TX 79760-2129 |
Second Address | Odessa, TX 79761-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2010 |
Last Update Date | 01/07/2016 |