Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | M5063 | ID |
NPI | 1063449221 |
---|---|
Provider Name | Nagraj Narasimhan |
First Address | Oklahoma City, OK 73126-8934 |
Second Address | Twin Falls, ID 83301-5788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001835200 | (05) | ID |
B36814 | (02) | ID |
P00431118 | RR MEDICARE (01) | ID |