Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 000020221 | AL |
N | 111NI0900X | Internist | 000020221 | AL |
Y | 207RN0300X | Nephrologist | 000020221 | AL |
NPI | 1033117817 |
---|---|
Provider Name | Dr. Rajesh Boorgu |
First Address | Florence, AL 35630-5763 |
Second Address | Florence, AL 35630-5763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 16/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000076742 | (05) | AL |
110208939 | MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL (01) | SC |
529400760 | (05) | AL |
CC6102 | MEDICARE RAILROAD/PALMETTO GBA - GROUP (01) | SC |
G68535 | (02) | AL |