Individual
JAGANNADHA RAO AVASARALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
740 S LIMESTONE KY CLINIC J401, LEXINGTON, KY 40536-0001
(859) 323-5661
Mailing address
740 S LIMESTONE KY CLINIC J401, LEXINGTON, KY 40536-0001
(859) 323-5661
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
2008028207
MO
2084N0400X
Neurology Physician
36752
SC
2084N0400X
Neurology Physician
Primary
51916
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972576940
TRIWEST
MO
05
—
1972576940
—
MO
05
—
Q0031C
—
SC
Enumeration date
02/09/2006
Last updated
05/02/2022
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