Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 52456 | AZ |
N | 207K00000X | Allergist & Immunologist | N5277 | TX |
NPI | 1164464590 |
---|---|
Provider Name | Dr. Madhu Babu Narra |
First Address | Yuma, AZ 85364-7763 |
Second Address | Yuma, AZ 85364-7763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
343795YQ3Y | MEDICARE PTAN (01) | TX |