Individual
AYYAPPA MYSORE RANGARAJU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2421 W 21ST ST STE B, CLOVIS, NM 88101-2006
(575) 769-7577
(575) 742-7856
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2017-0029
NM
207RG0100X
Gastroenterology Physician
Primary
MD2017-0029
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34803548
—
NM
Enumeration date
11/15/2012
Last updated
10/02/2017
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