Provider Demographics
NPI:1457372260
Name:MOVVA, VENKATESH (MD)
Entity type:Individual
Prefix:
First Name:VENKATESH
Middle Name:
Last Name:MOVVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S YALE AVE
Mailing Address - Street 2:#212
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-502-4000
Mailing Address - Fax:918-502-4001
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:#212
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-502-4000
Practice Address - Fax:918-502-4001
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20519208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK103863500OtherWC STATE OF OK
7999176OtherAETNA
OK248402301Medicare PIN
7999176OtherAETNA