Basic Information
| Provider Information | |||||||||
| NPI: | 1003992850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABU | ||||||||
| FirstName: | VEER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VEERENDRA-BABU | ||||||||
| OtherFirstName: | BADAVANAHALLI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 850 HARVARD WAY | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825262 | ||||||||
| FaxNumber: | 7759825496 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 RYLAND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825000 | ||||||||
| FaxNumber: | 7759825225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME74937 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | ME74937 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | MD28315 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 11598 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051544347 | 01 | AL | BCBS | OTHER | 009912142 | 05 | AL | MEDICAID | 100507751 | 05 | NV | MEDICAID |