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General NPI Number Information
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NPI Number | 1023208949
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Entity Type | Individual
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Provider Name | GOVARDHANA RAO YANNAM MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2060 SPACE PARK DR STE 100
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City | HOUSTON
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State | TX
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Zip | 77058-3674
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Country | US
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Telephone | 281-333-1703
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 SPACE PARK DR STE 100
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City | HOUSTON
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State | TX
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Zip | 77058-3674
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Country | US
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Telephone | 281-333-1703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 5541
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6026
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | Q9558
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License Number State | TX
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