Individual
RATNAM BABY NAGALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
870 OLIVE ST, SHREVEPORT, LA 71104-2159
(318) 629-0480
(318) 629-0483
Mailing address
870 OLIVE ST, SHREVEPORT, LA 71104-2159
(318) 629-0480
(318) 629-0483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD.03803R
LA
208000000X
Pediatrics Physician
Primary
MD.03803R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1152609
—
LA
Enumeration date
02/22/2007
Last updated
11/19/2012
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