Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 06666 | MS |
NPI | 1033124904 |
---|---|
Provider Name | Dr. Sybil F Raju |
First Address | Jackson, MS 39216 |
Second Address | Jackson, MS 39216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |