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General NPI Number Information
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NPI Number | 1164527883
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Entity Type | Individual
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Provider Name | LAKSHMA R TIYYAGURA MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 420 W ACACIA ST # 18
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City | STOCKTON
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State | CA
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Zip | 95203-2441
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Country | US
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Telephone | 209-466-4685
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Fax | 209-466-4695
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Provider Business Mailing Address
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Address Line | PO BOX 7939
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City | STOCKTON
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State | CA
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Zip | 95267-0939
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Country | US
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Telephone | 209-466-4685
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Fax | 204-466-4695
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A56285
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License Number State | CA
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