Individual
RAMAKRISHNA DEVASTHALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
160 S ROADRUNNER PKWY, LAS CRUCES, NM 88011-7044
(575) 556-1800
(575) 449-7006
Mailing address
PO BOX 13638, LAS CRUCES, NM 88013-3638
(575) 449-7005
(575) 449-7006
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
86-212
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05595
—
NM
01
—
201002438
PRESBYTERIAN HEALTH
NM
01
—
248520105
MEDICARE PTAN
—
01
—
NM010679
BCBS & HMO OF NM
NM
01
—
P00224034
RR MEDICARE
—
Enumeration date
03/14/2006
Last updated
01/13/2017
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