Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME117329 | FL |
N | 2086S0105X | Surgery of the Hand | 050608 | CT |
NPI | 1841596327 |
---|---|
Provider Name | Srikanth Eathiraju |
First Address | Port Orange, FL 32129-2300 |
Second Address | Port Orange, FL 32129-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 16/10/2014 |