Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 21587 | AL |
NPI | 1053415695 |
---|---|
Provider Name | Venugopala S Bheemanathini |
First Address | Anniston, AL 36207-4770 |
Second Address | Anniston, AL 36207-4770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009974770 | (05) | AL |
G20801 | (02) | AL |