Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 2002-0295 | NM |
Y | 207RC0000X | Internist - Cardiovascular Disease | L2101 | TX |
NPI | 1023007085 |
---|---|
Provider Name | Manohar Angirekula |
First Address | Odessa, TX 79761-4442 |
Second Address | Odessa, TX 79761-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149880003 | (05) | TX |