Individual
RANGANATHA PRASAD POTU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6122 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8722
(352) 228-8429
(352) 794-6326
Mailing address
6122 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8722
(352) 228-8429
(352) 794-6326
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0036819
FL
207RC0000X
Cardiovascular Disease Physician
ME36819
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001262401
—
FL
01
—
060000091
RAIL ROAD MEDICARE
FL
01
—
09052
BLUE CROSS/BLUE SHIELD
FL
01
—
095765662
TRI CARE FOR LIFE
FL
Enumeration date
04/19/2006
Last updated
07/21/2022
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