Provider Demographics
NPI:1336138601
Name:NAGALA, RUP K (MD)
Entity Type:Individual
Prefix:DR
First Name:RUP
Middle Name:K
Last Name:NAGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SOUTH 7TH ST
Mailing Address - Street 2:PO BOX 50
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0050
Mailing Address - Country:US
Mailing Address - Phone:701-742-3267
Mailing Address - Fax:701-742-3201
Practice Address - Street 1:420 S 7TH ST
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25961OtherBLUE SHIELD
ND12765Medicaid
ND18151OtherBLUE SHIELD
ND18154OtherBLUE SHIELD
25267OtherBLUE SHIELD
ND28578OtherBLUE SHIELD
ND18152OtherBLUE SHIELD
ND18155OtherBLUE SHIELD
ND18156OtherBLUE SHIELD
NDDD1370OtherRAILROAD MEDICARE
ND080027931OtherRAILROAD MEDICARE
ND13516Medicaid
NDCF8850OtherRAILROAD MEDICARE
NDP00210261OtherRAILROAD MEDICARE
NDP00210261OtherRAILROAD MEDICARE
NDN25267Medicare Oscar/Certification
NDN25267Medicare PIN
ND18152OtherBLUE SHIELD
NDCF8850OtherRAILROAD MEDICARE
25267OtherBLUE SHIELD
ND12765Medicaid
NDDD1370OtherRAILROAD MEDICARE
NDCF8850Medicare PIN