Provider Demographics
NPI:1811290810
Name:PATURI, VEERA VENKATA S BABU (MBBS)
Entity type:Individual
Prefix:DR
First Name:VEERA VENKATA S BABU
Middle Name:
Last Name:PATURI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E ASH ST
Mailing Address - Street 2:1
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2029
Mailing Address - Country:US
Mailing Address - Phone:850-584-3278
Mailing Address - Fax:
Practice Address - Street 1:315 E ASH ST
Practice Address - Street 2:1
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2029
Practice Address - Country:US
Practice Address - Phone:850-584-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015926600Medicaid