Organization
DEVARAKONDA & RAJENDRAN MD S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUBRANMANYAM DEVARAKONDA MD (OWNER)
(813) 752-1053
Entity
Organization
Contact information
Practice address
1507 W REYNOLDS ST, STE B, PLANT CITY, FL 33563-4702
(813) 752-1053
(813) 754-6739
Mailing address
1507 W REYNOLDS ST, STE B, PLANT CITY, FL 33563-4702
(813) 752-1053
(813) 754-6739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060981100
—
FL
01
—
98568
BCBS
FL
01
—
CB7529
RAILROAD
FL
Enumeration date
07/08/2006
Last updated
08/05/2010
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