Healthcare Provider Details

I. General information

NPI: 1447222575
Provider Name (Legal Business Name): JAYACHANDRA R. INDURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EAGLE POINT DR
NEW ORLEANS LA
70131-3380
US

IV. Provider business mailing address

11 EAGLE POINT DR
NEW ORLEANS LA
70131-3380
US

V. Phone/Fax

Practice location:
  • Phone: 504-723-5313
  • Fax: 915-545-6984
Mailing address:
  • Phone: 504-723-5313
  • Fax: 915-545-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41137
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number069109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: