Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 26533 | OK |
Y | 2080P0205X | Pediatric Endocrinologist | 26533 | OK |
NPI | 1376709816 |
---|---|
Provider Name | Paul Shirodeep Dasari |
First Address | Oklahoma City, OK 73104-4637 |
Second Address | Oklahoma City, OK 73104-5047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 24/07/2015 |