Provider Demographics
NPI:1104891332
Name:JUJJAVARAPU, RAYUDU (M D)
Entity type:Individual
Prefix:DR
First Name:RAYUDU
Middle Name:
Last Name:JUJJAVARAPU
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:JUJJAVARAPU
Other - Middle Name:
Other - Last Name:RAYUDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-0015
Mailing Address - Country:US
Mailing Address - Phone:512-556-3621
Mailing Address - Fax:
Practice Address - Street 1:2207 CLEAR CREEK RD STE 203
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4133
Practice Address - Country:US
Practice Address - Phone:254-519-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043718208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007305826Medicaid
VA110950OtherANTHEM BCBS
020031502Medicare PIN
VAE04355Medicare UPIN
VA007305826Medicaid