Individual
INDRAVADAN VYAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 CEDAR ST SE STE 4660, ALBUQUERQUE, NM 87106-4924
(505) 563-6530
(505) 563-6336
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME0084182
FL
2086S0120X
Pediatric Surgery Physician
Primary
MD2016-0003
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264836900
—
FL
05
—
32756526
—
NM
Enumeration date
10/13/2005
Last updated
01/17/2017
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