Individual
BHAGVAN R MALLADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
319 GASLIGHT BLVD, LUFKIN, TX 75901
(936) 634-3713
(936) 634-8136
Mailing address
319 GASLIGHT BLVD, LUFKIN, TX 75901
(936) 634-3713
(936) 634-8136
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G2092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035782401
—
TX
01
—
8J3446
BLUE CROSS
TX
Enumeration date
08/10/2005
Last updated
12/12/2012
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