Provider Demographics
NPI:1386691202
Name:YTURRI, THOMAS E (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:YTURRI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1834
Mailing Address - Country:US
Mailing Address - Phone:512-379-6090
Mailing Address - Fax:512-379-6098
Practice Address - Street 1:311 S HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1834
Practice Address - Country:US
Practice Address - Phone:512-379-6090
Practice Address - Fax:512-379-6098
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS57063Medicare UPIN
TXS57063Medicare UPIN