Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01063531A | IN |
Y | 208600000X | Surgeon | 01063531A | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01063531A | IN |
NPI | 1255380671 |
---|---|
Provider Name | Venkata S Erella |
First Address | Austin, TX 78720 |
Second Address | Austin, TX 78759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 05/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000525700 | ANTHEM BLUE SHIELD (01) | IN |
200863480 | (05) | IN |
I52818 | (02) |