Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 0101249330 | VA |
Y | 207RR0500X | Rheumatology | P2022 | TX |
NPI | 1124262209 |
---|---|
Provider Name | Swapna Koduru |
First Address | Abilene, TX 79604-1198 |
Second Address | Abilene, TX 79601-2325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 11/09/2014 |