Healthcare Provider Details

I. General information

NPI: 1144294711
Provider Name (Legal Business Name): SRIDHAR NARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 JEFFERSON ST STE A
AUSTIN TX
78731-6206
US

IV. Provider business mailing address

3708 JEFFERSON ST STE A
AUSTIN TX
78731-6206
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-6503
  • Fax: 512-454-7453
Mailing address:
  • Phone: 512-459-6503
  • Fax: 512-454-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301074999
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN1401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: