Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 27452 | AL |
NPI | 1043267917 |
---|---|
Provider Name | Dr. Venkat R Nimmagadda |
First Address | Dothan, AL 36301-3012 |
Second Address | Dothan, AL 36301-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051557983 | ID (01) | AL |
51538580 | BCBS ALABAMA (01) | AL |
I61586 | (02) |