Sreedhar Polavarapu MD PA
Internal Medicine, Geriatric Medicine in Port Arthur, TX. Organization (NPI-2).
NPI number1114009586
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1114009586
- Entity type
- Organization (NPI-2)
- Legal business name
- Sreedhar Polavarapu MD PA
- Organization subpart
- No
- Enumeration date
- Oct 19, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0300X | Internal Medicine, Geriatric Medicine | L9431 | TX | Yes |
Practice location
2501 Jimmy Johnson BlvdSuite 207
Port Arthur, TX 77642
Phone 409-722-7500 · Fax 409-293-4401
Mailing address
2501 Jimmy Johnson BlvdSuite 207
Port Arthur, TX 77642
Phone 409-722-7500 · Fax 409-293-4401
Authorized official
Sreedhar Polavarapu
President
4097227500
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