Basic Information
| Provider Information | |||||||||
| NPI: | 1407007115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUKKAPATNAM | ||||||||
| FirstName: | JAYASRI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 4074255947 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 4074255947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME104383 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.