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General NPI Number Information
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NPI Number | 1316142268
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Entity Type | Individual
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Provider Name | SUBHASH K NAGALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 420 E 6TH ST STE 102
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-888-9001
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Fax | 324-888-9002
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Provider Business Mailing Address
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Address Line | 420 E 6TH ST STE 102
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-888-9001
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Fax | 324-888-9002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036126261
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME98793
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD435582
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | P4790
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License Number State | TX
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