Provider Demographics
NPI:1700117355
Name:S IYER PA
Entity Type:Organization
Organization Name:S IYER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-565-0373
Mailing Address - Street 1:PO BOX 50658
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0658
Mailing Address - Country:US
Mailing Address - Phone:940-565-0373
Mailing Address - Fax:940-565-0413
Practice Address - Street 1:802 NORTH BONNIE BRAE STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2301
Practice Address - Country:US
Practice Address - Phone:940-565-0373
Practice Address - Fax:940-565-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213642601Medicaid
TX213642601Medicaid