MEDICARE: DR. JAYA VANISTI JUTURI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	L2957	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00789794	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8CA989	OTHER	TX	BLUECROSS BLUESHIELD OF TEXAS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710976626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYA VANISTI JUTURI MD

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-0813

Provider Business Practice Location Address
First Line	:	8220 WALNUT HILL LN
Second Line	:	SUITE 700
City	:	DALLAS
State	:	TX
Zip	:	75231-4427
Country	:	US
Telephone Number	:	214-739-4175
Fax Number	:	214-987-4161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	03/11/2010

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