Provider Demographics
NPI:1861571622
Name:YERNENI, PURNACHANDRA RAO (MD)
Entity type:Individual
Prefix:MR
First Name:PURNACHANDRA
Middle Name:RAO
Last Name:YERNENI
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 1:1011 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4334
Mailing Address - Country:US
Mailing Address - Phone:985-732-9940
Mailing Address - Fax:985-732-9979
Practice Address - Street 1:1011 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4334
Practice Address - Country:US
Practice Address - Phone:985-732-9940
Practice Address - Fax:985-732-9979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10096R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE62520Medicare UPIN
LA5R893Medicare PIN