Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 302690 | LA |
N | 111NI0900X | Internist | 302690 | LA |
Y | 207RN0300X | Nephrologist | 302690 | LA |
NPI | 1053756924 |
---|---|
Provider Name | Phani Purushotham Morisetti |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 04/09/2019 |