Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 21102 | OK |
Y | 207RX0202X | Medical Oncology | 21102 | OK |
NPI | 1043257413 |
---|---|
Provider Name | Dr. Ravikumar Vasireddy |
First Address | Dallas, TX 75267-8453 |
Second Address | Muskogee, OK 74401-5037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100027960A | (05) | OK |
G15444 | (02) | OK |