Provider Demographics
NPI:1629473103
Name:MURTHY, YEDATORE (MD)
Entity Type:Individual
Prefix:
First Name:YEDATORE
Middle Name:
Last Name:MURTHY
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:6.136G JOHN SEALY ANNEX
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0527
Mailing Address - Country:US
Mailing Address - Phone:409-772-3620
Mailing Address - Fax:409-772-5611
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:6.136G JOHN SEALY ANNEX
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0527
Practice Address - Country:US
Practice Address - Phone:409-772-3620
Practice Address - Fax:409-772-5611
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology