Individual
MR. BALI REDDY SODAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4417 W GORE BLVD, SUITE 1, LAWTON, OK 73505-5978
(580) 536-5273
(580) 357-8500
Mailing address
4417 W GORE BLVD, SUITE 1, LAWTON, OK 73505-5978
(580) 536-5273
(580) 357-2423
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
24723
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200074670A
—
OK
Enumeration date
08/16/2006
Last updated
12/08/2010
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