Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 2016022748 | MO |
NPI | 1013175389 |
---|---|
Provider Name | Dr. Sridevi Durga |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013175389 | (05) | MO |
200034795 | (05) | MO |