Individual
DR. JAYA RUTH ASIRVATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS, MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0371
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
ME128310
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
S4718
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018025500
—
FL
05
—
407815601
—
TX
01
—
941227
MEDICARE
TX
Enumeration date
08/31/2011
Last updated
09/04/2020
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