Provider Demographics
NPI:1982660593
Name:JAGANNADHA R. VYAPAKA, M.D.,P.A.
Entity Type:Organization
Organization Name:JAGANNADHA R. VYAPAKA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGANNADHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VYAPAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-622-5536
Mailing Address - Street 1:129 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4267
Mailing Address - Country:US
Mailing Address - Phone:352-622-5536
Mailing Address - Fax:352-622-5883
Practice Address - Street 1:129 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4267
Practice Address - Country:US
Practice Address - Phone:352-622-5536
Practice Address - Fax:352-622-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0039126207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85738Medicare UPIN
FL42176Medicare PIN