Healthcare Provider Details

I. General information

NPI: 1881672897
Provider Name (Legal Business Name): PALUR V. SRIDHARAN M.D.,F.A.C.S.,F.I.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 8TH ST
RAWLINS WY
82301-5418
US

IV. Provider business mailing address

PO BOX 2139
RAWLINS WY
82301-2139
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-2705
  • Fax: 307-324-2923
Mailing address:
  • Phone: 307-324-2705
  • Fax: 307-324-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2923A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: