Provider Demographics
NPI:1053378448
Name:SREENARASIMHAIAH, JAYAPRAKASH (MD)
Entity type:Individual
Prefix:
First Name:JAYAPRAKASH
Middle Name:
Last Name:SREENARASIMHAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-8600
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN DR STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3838
Practice Address - Country:US
Practice Address - Phone:214-496-1100
Practice Address - Fax:214-496-1110
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4730207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151465501Medicaid
H62351Medicare UPIN