Healthcare Provider Details

I. General information

NPI: 1184604993
Provider Name (Legal Business Name): LAXMI NARAYANA RAJU BUDDHARAJU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S. 48TH ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

98102 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5600
  • Fax: 402-559-6615
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number21789
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number21789
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: