Provider Demographics
NPI:1215911573
Name:BHYRAVABHOTLA, RAMA (PA-C)
Entity type:Individual
Prefix:MR
First Name:RAMA
Middle Name:
Last Name:BHYRAVABHOTLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:27 05 EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-5604
Mailing Address - Country:US
Mailing Address - Phone:850-283-7589
Mailing Address - Fax:850-283-7129
Practice Address - Street 1:325 MDOS/SGOMF
Practice Address - Street 2:340 MAGNOLIA CIRCLE
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403
Practice Address - Country:US
Practice Address - Phone:850-283-7589
Practice Address - Fax:850-283-7129
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant