Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | E9923 | TX |
NPI | 1013977958 |
---|---|
Provider Name | Dr. Anjaneya Puppala |
First Address | Dallas, TX 75247-4231 |
Second Address | Richardson, TX 75080-3595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 27/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122772003 | (05) | TX |
85Y157 | BCBSTX (01) | TX |
B25694 | (02) | TX |