DR. VASUDEVA M BOMMANNA MD
Allergy and Immunology
Nacogdoches, Texas
Provider NPI: 1477594836
Provider Information:DR. VASUDEVA M BOMMANNA MD
Practice Location:
607 RUSSELL BLVD SUITE ' B' NACOGDOCHES, TX 75965 US
Tel: 936-559-7750 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207K00000X | Physicians Allergy & Immunology | TX | K 3685 |
| Y | 207KA0200X | Physicians Allergy & Immunology | TX | K 3685 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE CROSS # | 0020CF | TX | 01 |
| MEDICARE # FOR WEBSTER | 612574 | TX | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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