Organization
COMANCHE NEPHROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BALI REDDY SODAM M.D. (PHYSICIAN)
(580) 536-5273
Entity
Organization
Contact information
Practice address
4417 W GORE BLVD, SUITE 1, LAWTON, OK 73505-5978
(580) 536-5273
Mailing address
4417 W GORE BLVD, SUITE 1, LAWTON, OK 73505-5978
(580) 536-5273
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
24723
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200123460A
—
OK
Enumeration date
10/23/2007
Last updated
12/11/2010
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