Basic Information
| Provider Information | |||||||||
| NPI: | 1710174867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYIRALA | ||||||||
| FirstName: | SRILATHA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3106 NW ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802504278 | ||||||||
| FaxNumber: | 5805811548 | ||||||||
| Practice Location | |||||||||
| Address1: | 3106 NW ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735056123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802504278 | ||||||||
| FaxNumber: | 5805811548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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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 | 207RC0000X | 30185 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 200506780 | 05 | OK | MEDICAID | 340928 | 05 | SC | MEDICAID |