MEDICARE: DR. NAGA L BATTALA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A104785	CA
2	174400000X	Specialist	A104785	CA
3	207V00000X	Obstetrics & Gynecology Physician	10119A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27-3952577	OTHER	CA	OM SAI OBGYN CLINIC TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730372830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGA L BATTALA M.D.

Provider Business Mailing Address
First Line	:	3000 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4202
Country	:	US
Telephone Number	:	307-362-1861
Fax Number	:	307-362-1277

Provider Business Practice Location Address
First Line	:	3000 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4202
Country	:	US
Telephone Number	:	307-362-1861
Fax Number	:	307-362-1277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	12/18/2015

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