# RAJA TALLURI MD A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thibodaux Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083727838
- **Authorized official:** MRS. GAYATHRI TALLURI MD (OWNER)
- **Authorized official phone:** (985) 414-0682

## Contact information

- **Practice address:** 931 N CANAL BLVD, THIBODAUX, LA 70301-8095
- **Practice address phone:** (985) 446-6381
- **Practice address fax:** (985) 446-5992
- **Mailing address:** 1214 CARDINAL DR, THIBODAUX, LA 70301-4815
- **Mailing address phone:** (985) 446-6381
- **Mailing address fax:** (985) 446-5992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 07/07/2022