MEDICARE: DR. VANAMA YERRA 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	207R00000X	Internal Medicine Physician	22719	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437246717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANAMA YERRA MD

Provider Business Mailing Address
First Line	:	820 W DANFORTH RD
Second Line	:	B-30
City	:	EDMOND
State	:	OK
Zip	:	73003-5006
Country	:	US
Telephone Number	:	405-602-3553
Fax Number	:	405-602-3556

Provider Business Practice Location Address
First Line	:	820 W DANFORTH RD
Second Line	:	B-30
City	:	EDMOND
State	:	OK
Zip	:	73003-5006
Country	:	US
Telephone Number	:	405-602-3553
Fax Number	:	405-602-3556

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/12/2009

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