Individual
DR. LAKSHMI DATLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1717 S J ST, MS 01-36 FRANCISCAN INPATIENT TEAM, TACOMA, WA 98405-4933
(253) 426-6363
Mailing address
1058 MCDONALD AVE, DUPONT, WA 98327-9755
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125052423
IL
207R00000X
Internal Medicine Physician
Primary
MD60197513
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0273837
L&I
WA
01
—
G8897542
MEDICARE
WA
01
—
G8897543
MEDICARE
WA
Enumeration date
05/05/2008
Last updated
01/08/2015
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