Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | F8398 | TX |
NPI | 1023094703 |
---|---|
Provider Name | Ravinder R Bachireddy |
First Address | Lufkin, TX 75904-3133 |
Second Address | Lufkin, TX 75904-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127937403 | (05) | TX |
B21045 | (02) | TX |