Provider Demographics
NPI:1710976626
Name:JUTURI, JAYA VANISTI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:VANISTI
Last Name:JUTURI
Suffix:
Gender:F
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-739-4175
Practice Address - Fax:214-987-4161
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2957207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148695302Medicaid
TX8CA989OtherBLUECROSS BLUESHIELD OF TEXAS
TXP00789794OtherRAILROAD MEDICARE
TX148695303Medicaid
TX148695301Medicaid
TX8CA989OtherBLUECROSS BLUESHIELD OF TEXAS
TXP00789794OtherRAILROAD MEDICARE
TX148695302Medicaid
TX8C6127Medicare PIN
TXH51930Medicare UPIN