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General NPI Number Information
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NPI Number | 1760674212
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Entity Type | Organization
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Legal Business Name | VIJAYRAMA POREDDY, MD, PA
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 12201 RENFERT WAY STE 365
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City | AUSTIN
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State | TX
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Zip | 78758-5354
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Country | US
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Telephone | 512-491-5186
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Fax | 512-491-5203
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Provider Business Mailing Address
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Address Line | 12201 RENFERT WAY STE 365
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City | AUSTIN
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State | TX
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Zip | 78758-5354
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Country | US
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Telephone | 512-491-5186
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Fax | 512-491-5203
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIJARAMA POREDDY
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Credential |
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Telephone | 512-419-5186
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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 | L9434
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License Number State | TX
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