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Organization
RAJA TALLURI MD A PROFESSIONAL MEDICAL CORPORATION
Active
Organization
RAJA TALLURI MD A PROFESSIONAL MEDICAL CORPORATION
Active
Other names
Thibodaux Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAYATHRI TALLURI MD (OWNER)
(985) 414-0682
Entity
Organization
Contact information
Practice address
931 N CANAL BLVD, THIBODAUX, LA 70301-8095
(985) 446-6381
(985) 446-5992
Mailing address
1214 CARDINAL DR, THIBODAUX, LA 70301-4815
(985) 446-6381
(985) 446-5992
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/16/2006
Last updated
07/07/2022
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