Provider Demographics
NPI:1063510774
Name:APPURAO, JAYAGOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYAGOPAL
Middle Name:
Last Name:APPURAO
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:P O BOX 919313
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:855-707-1542
Mailing Address - Fax:337-237-5102
Practice Address - Street 1:433 PLAZA ST STE 3A
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3729
Practice Address - Country:US
Practice Address - Phone:985-730-7030
Practice Address - Fax:985-730-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.05072R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309338Medicaid
LAB89359Medicare UPIN
LA1309338Medicaid