Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | M5001 | TX |
NPI | 1063595890 |
---|---|
Provider Name | Dr. Lakshmi Malathy Puvvada |
First Address | Palestine, TX 75801-8491 |
Second Address | Palestine, TX 75801-8491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 01/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F98581 | (02) | TX |