Individual
PAVANA NAGA GOPI KRISHNA TIRUMANISETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 W 40TH AVE, PINE BLUFF, AR 71603-6069
(870) 541-6000
(870) 541-6009
Mailing address
4021 W 8TH ST, LITTLE ROCK, AR 72204-2029
(501) 686-5021
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
206188
LA
207Q00000X
Family Medicine Physician
Primary
E-13165
AR
208M00000X
Hospitalist Physician
206188
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2118013
—
LA
Enumeration date
08/27/2010
Last updated
09/22/2020
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