Individual
DR. JAYACHANDRA BABU VAVILATHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
146 W DALE ST, SUITE 201, WATERLOO, IA 50703-1901
(319) 234-4431
(319) 235-5004
Mailing address
PO BOX 1455, DES MOINES, IA 50306-1455
(515) 471-9243
(515) 471-9319
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942455746
—
IA
01
—
P00741043
RR MEDICARE
IA
Enumeration date
11/20/2008
Last updated
09/28/2009
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