Provider Demographics
NPI:1568478238
Name:MEMULA, NARAYANA G (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAYANA
Middle Name:G
Last Name:MEMULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NARAYANA
Other - Middle Name:GOUD
Other - Last Name:MEMULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:6770 BROWN LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8652
Mailing Address - Country:US
Mailing Address - Phone:573-560-1008
Mailing Address - Fax:573-560-1008
Practice Address - Street 1:1800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1218
Practice Address - Country:US
Practice Address - Phone:909-887-8800
Practice Address - Fax:909-887-5678
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC521622085R0001X
MOR84312085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR8431OtherMEDICALLICENSE
MOR8431OtherMEDICAL LICENSE