Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD26229 | OR |
N | 111NI0900X | Internist | MD26229 | OR |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD26229 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | MD26229 | OR |
NPI | 1437167962 |
---|---|
Provider Name | Pulla Raghuram Reddy |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023274 | (05) | OR |
H16205 | (02) |