MEDICARE: DR. RAM SUBBUREDDIAR MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	30466	AZ

General Provider Information

NPI Number	:	1326016221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAM SUBBUREDDIAR MD

Provider Business Mailing Address
First Line	:	7757 E BLACK CREST PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-7412
Country	:	US
Telephone Number	:	520-546-6994
Fax Number	:	520-546-6994

Provider Business Practice Location Address
First Line	:	6556 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2117
Country	:	US
Telephone Number	:	520-296-8733
Fax Number	:	520-296-8734

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/29/2007

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