Individual
DR. SRIVIDYA SRIDHARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
623 W FM 544, STE 104, MURPHY, TX 75094-4577
(972) 521-3366
(972) 422-5656
Mailing address
6210 GEORGIAN CT, DALLAS, TX 75254-8652
(408) 431-0256
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
104968
MN
207K00000X
Allergy & Immunology Physician
53480
MN
207K00000X
Allergy & Immunology Physician
A107039
CA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
P4113
TX
390200000X
Student in an Organized Health Care Education/Training Program
25109
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
02/13/2007
Last updated
10/28/2024
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