Individual
DR. SOWMYA BODDHULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
705 E MARSHALL AVE STE 1002, LONGVIEW, TX 75601-5660
(903) 315-4422
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
(607) 547-6612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
288270
NY
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
T1906
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1R9519
MEDICARE
TX
05
—
428571001
—
TX
01
—
8QD098
BCBS
TX
Enumeration date
06/27/2013
Last updated
09/12/2024
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