Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | M2851 | TX |
NPI | 1427082171 |
---|---|
Provider Name | Sreenadha Reddy Vattam |
First Address | Sherman, TX 75090-3124 |
Second Address | Sherman, TX 75090-3124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I37401 | (02) |