Provider Demographics
NPI:1245531490
Name:H V IYER MD PA
Entity type:Organization
Organization Name:H V IYER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:V
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-628-7672
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34447-3089
Mailing Address - Country:US
Mailing Address - Phone:352-628-7672
Mailing Address - Fax:352-628-5190
Practice Address - Street 1:3475 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2322
Practice Address - Country:US
Practice Address - Phone:352-628-7672
Practice Address - Fax:352-628-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044371208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048855100Medicaid
FL09070OtherBLUE CROSS BLUE SHIELD
FL09070OtherBLUE SHIELD HEALTH OPTION
FL110023029OtherRAILROAD MEDICARE
FL217649OtherAVMED
FL217649OtherAVMED
FL048855100Medicaid