Provider Demographics
NPI:1043299712
Name:IYER, SRIDHAR KRISHNAMURTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:KRISHNAMURTHY
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SRIDHAR
Other - Middle Name:
Other - Last Name:KRISHNAMURTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 50658
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0658
Mailing Address - Country:US
Mailing Address - Phone:940-565-0373
Mailing Address - Fax:940-565-0413
Practice Address - Street 1:802 NORTH BONNIE BRAE STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2301
Practice Address - Country:US
Practice Address - Phone:940-565-0373
Practice Address - Fax:940-565-0413
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5739207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213952901Medicaid
TXTXB101387Medicare PIN