# DEEPIKA RALLA MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508335738
- **Authorized official:** DEEPIKA REDDY RALLA MD (MEMBER MANAGER)
- **Authorized official phone:** (201) 455-6383

## Contact information

- **Practice address:** 2525 VIKING DR, BOSSIER CITY, LA 71111-2103
- **Practice address phone:** (318) 841-2525
- **Mailing address:** PO BOX 1684, SHREVEPORT, LA 71165-1684
- **Mailing address phone:** (318) 424-4008
- **Mailing address fax:** (855) 230-1466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2018
- **Last updated:** 11/16/2018