Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 21103 | OK |
NPI | 1043303084 |
---|---|
Provider Name | Dr. Anand Deviprakash Udupa |
First Address | Tulsa, OK 74136-7823 |
Second Address | Tulsa, OK 74136-7823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100026940A | (05) | OK |
G93904 | (02) |