Individual
DR. VASUDEVA M BOMMANNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
607 RUSSELL BLVD, SUITE ' B', NACOGDOCHES, TX 75965-1247
(936) 559-7750
(936) 559-7807
Mailing address
607 RUSSELL BLVD, SUITE ' B', NACOGDOCHES, TX 75965-1247
(936) 559-7750
(936) 559-7807
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
K 3685
TX
207KA0200X
Allergy Physician
Primary
K 3685
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020CF
BLUE CROSS #
TX
01
—
612574
MEDICARE # FOR WEBSTER
TX
Enumeration date
06/09/2006
Last updated
07/16/2007
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