Healthcare Provider Details

I. General information

NPI: 1033406731
Provider Name (Legal Business Name): PRADEEP YARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 WURZBACH RD
SAN ANTONIO TX
78229-3921
US

IV. Provider business mailing address

8435 WURZBACH RD
SAN ANTONIO TX
78229-3921
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9800
  • Fax:
Mailing address:
  • Phone: 210-450-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50520
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV8438
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberV8438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: