Provider Demographics
NPI:1023208949
Name:YANNAM, GOVARDHANA RAO (MD)
Entity Type:Individual
Prefix:
First Name:GOVARDHANA
Middle Name:RAO
Last Name:YANNAM
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 1:2060 SPACE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3674
Mailing Address - Country:US
Mailing Address - Phone:281-333-1703
Mailing Address - Fax:
Practice Address - Street 1:2060 SPACE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3674
Practice Address - Country:US
Practice Address - Phone:281-333-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5541204F00000X
GA6026208600000X
TXQ9558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373627401Medicaid