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General NPI Number Information
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NPI Number | 1043529548
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Entity Type | Individual
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Provider Name | SRINIVASA REDDY YERASI M.D
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Gender | Male
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 555 LAKES BLVD
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-3240
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Country | US
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Telephone | 337-332-3971
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Fax | 337-332-3973
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Provider Business Mailing Address
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Address Line | 401 YOUNGSVILLE HWY SUITE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-5173
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Country | US
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Telephone | 337-330-0031
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Fax | 337-330-0059
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 204209
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License Number State | LA
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