Provider Demographics
NPI:1447222575
Name:INDURU, JAYACHANDRA R (MD)
Entity Type:Individual
Prefix:
First Name:JAYACHANDRA
Middle Name:R
Last Name:INDURU
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 1:11 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3380
Mailing Address - Country:US
Mailing Address - Phone:504-723-5313
Mailing Address - Fax:915-545-6984
Practice Address - Street 1:11 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3380
Practice Address - Country:US
Practice Address - Phone:504-723-5313
Practice Address - Fax:915-545-6984
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41137207L00000X
LA069109207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F47442Medicare UPIN