Provider Demographics
NPI:1841256450
Name:VYAPAKA, JAGANNADHA R (MD)
Entity type:Individual
Prefix:DR
First Name:JAGANNADHA
Middle Name:R
Last Name:VYAPAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4267
Mailing Address - Country:US
Mailing Address - Phone:352-622-5536
Mailing Address - Fax:352-622-5883
Practice Address - Street 1:129 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4267
Practice Address - Country:US
Practice Address - Phone:352-622-5536
Practice Address - Fax:352-622-5883
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0039126207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42176Medicare ID - Type Unspecified
FLD85738Medicare UPIN