Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 21535 | OK |
NPI | 1003981135 |
---|---|
Provider Name | Mr. Anil Kumar Reddy |
First Address | Tulsa, OK 74133-4569 |
Second Address | Tulsa, OK 74133-4569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100010230B | (05) | OK |
200216530A | (05) | OK |
H15045 | (02) | OK |