Provider Demographics
NPI:1881672897
Name:SRIDHARAN, PALUR V (MD,FACS,FIC)
Entity Type:Individual
Prefix:
First Name:PALUR
Middle Name:V
Last Name:SRIDHARAN
Suffix:
Gender:M
Credentials:MD,FACS,FIC
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 2139
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-2139
Mailing Address - Country:US
Mailing Address - Phone:307-324-2705
Mailing Address - Fax:307-324-2923
Practice Address - Street 1:519 8TH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5418
Practice Address - Country:US
Practice Address - Phone:307-324-2705
Practice Address - Fax:307-324-2923
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2923A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA72970Medicare UPIN
WY301091Medicare ID - Type Unspecified