Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 18659 | OK |
Y | 111NI0900X | Internist | 18659 | OK |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 18659 | OK |
NPI | 1043288194 |
---|---|
Provider Name | Dr. Naga Manohar Javvaji |
First Address | Muskogee, OK 74401 |
Second Address | Muskogee, OK 74401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100226510A | (05) | OK |
F24062 | (02) | OK |
P00182610 | RAILROAD MEDICARE (01) | OK |