Provider Demographics
NPI:1437246717
Name:YERRA, VANAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANAMA
Middle Name:
Last Name:YERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VANAMA
Other - Middle Name:
Other - Last Name:YERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:820 W DANFORTH RD
Mailing Address - Street 2:B-30
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5006
Mailing Address - Country:US
Mailing Address - Phone:405-602-3553
Mailing Address - Fax:405-602-3556
Practice Address - Street 1:820 W DANFORTH RD
Practice Address - Street 2:B-30
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5006
Practice Address - Country:US
Practice Address - Phone:405-602-3553
Practice Address - Fax:405-602-3556
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200219490AMedicaid
OK200219490AMedicaid
OKOK401685Medicare PIN