Individual
DR. PASAM SUDERSHAN RAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1107 AUDUBON AVE A, THIBODAUX, LA 70301-4940
(985) 447-7004
(985) 447-7003
Mailing address
103 ALLENDALE DR, THIBODAUX, LA 70301-8031
(985) 447-7004
(985) 447-7003
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
12265R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1534994
—
LA
Enumeration date
02/15/2007
Last updated
09/28/2015
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