Provider Demographics
NPI:1780106823
Name:JAYAGURUNATHAN, USHA (MD)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:JAYAGURUNATHAN
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 1:4183 E STONE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6652
Mailing Address - Country:US
Mailing Address - Phone:520-328-7199
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 245067
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5067
Practice Address - Country:US
Practice Address - Phone:520-626-3587
Practice Address - Fax:520-626-1945
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ621962085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program