Provider Demographics
NPI:1407066988
Name:PUNNAM, JYOTHI (MD)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:PUNNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JYOTHI
Other - Middle Name:
Other - Last Name:ENUGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-0002
Mailing Address - Country:US
Mailing Address - Phone:520-796-2600
Mailing Address - Fax:602-528-1296
Practice Address - Street 1:483 W SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-5000
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40129208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ371082Medicaid
AZZ138069Medicare PIN