Individual
VENKATA S ERELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11851 JOLLYVILLE RD, SUITE#104, AUSTIN, TX 78759
(512) 730-3885
(512) 730-3875
Mailing address
PO BOX 201450, AUSTIN, TX 78720
(512) 730-3885
(512) 730-3875
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01063531A
IN
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
01063531A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000525700
ANTHEM BLUE SHIELD
IN
05
—
200863480
—
IN
Enumeration date
05/10/2006
Last updated
09/05/2014
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