Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | J2830 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | J2830 | TX |
NPI | 1093866790 |
---|---|
Provider Name | Dr. Balu Swamy Viswanathan |
First Address | Lubbock, TX 79453 |
Second Address | Lubbock, TX 79415-3364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00J07N | BLUE CROSS (01) | TX |
F12070 | (02) | TX |