Provider Demographics
NPI:1013112341
Name:MURTHY, JYOTI SRIDHAR (MD)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:SRIDHAR
Last Name:MURTHY
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 1:3044 OLD DENTON ROAD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5099
Mailing Address - Country:US
Mailing Address - Phone:972-245-0007
Mailing Address - Fax:972-245-9272
Practice Address - Street 1:3044 OLD DENTON ROAD
Practice Address - Street 2:SUITE 138
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5099
Practice Address - Country:US
Practice Address - Phone:972-245-0007
Practice Address - Fax:972-245-9272
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165490703Medicaid
TXL8138OtherLICENSE TX